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Oldest-old patients (≥ 80 years) experiencing their first acute ischemic stroke possess a more favorable Circle of Willis configuration than younger elderly patients, an association that delays stroke onset and is markedly enhanced in females. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

October 29, 2025Open Access

Superior circle of Willis configuration in oldest-old patients with first-ever ischemic stroke: a retrospective clinical-radiological study on its association with delayed onset and enhanced female prominence

SJShu‐Sheng JiaoBethune International Peace Hospital JZJianxia ZhiBethune International Peace Hospital MLMiaomiao LiUniversity of Electronic Science and Technology of China

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Abstract

BACKGROUND: This study characterized the Circle of Willis (CoW) configuration in oldest-old (≥ 80 years) patients with first-ever acute ischemic stroke (AIS) and investigated its association with the age of AIS onset in the elderly. METHODS: In this retrospective, single-center clinical-radiological study, consecutive patients presenting with first-ever AIS at Bethune International Peace Hospital (Shijiazhuang, Hebei, China) between March 2022 and June 2024 were retrospectively enrolled and stratified into oldest-old (≥ 80) and elderly (60-79) groups. CoW morphology was assessed via brain magnetic resonance angiography (MRA) or computed tomography angiography (CTA) using CoW scores and types. RESULTS: A total of 276 patients were included in the final analysis based on our inclusion and exclusion criteria (188 aged 60-79; 88 aged ≥ 80). The oldest-old group (≥ 80 years) comprised a higher proportion of females (47.1% vs. 31.4%) and showed a greater prevalence of atrial fibrillation (17.1% vs. 5.3%) and coronary heart disease (26.1% vs. 10.6%) compared to the younger elderly group. The oldest-old group exhibited significantly higher anterior communicating artery (AcoA) scores, total CoW scores, and a greater prevalence of a complete CoW than the younger elderly group. A poorer CoW configuration was associated with an earlier age of AIS onset, while a higher AcoA score predicted a later onset, even after adjusting for risk factors. These associations were significantly more pronounced in females. Among females, the oldest-old had higher AcoA, posterior communicating artery (PcoA), and total CoW scores. The age of onset in females was significantly associated with AcoA score, total CoW score, and poorer configuration. CONCLUSIONS: Oldest-old patients with first-ever AIS possess a more favorable CoW configuration than younger elderly patients, an association markedly enhanced in females.

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