The Anatomy of the Circle of Willis Is Not a Strong Enough Predictive Factor for the Prognosis of Cross-Clamping Intolerance during Carotid Endarterectomy
Open Access
- 2 December 2020
- journal article
- research article
- Published by MDPI AG in Journal of Clinical Medicine
- Vol. 9 (12), 3913
- https://doi.org/10.3390/jcm9123913
Abstract
Carotid endarterectomy (CEA) is safe and effective in reducing the risk of stroke in symptomatic severe carotid artery stenosis. Having information about cross-clamping (CC) intolerance before surgery may reduce the complication rate. The purpose of this study was to assess the usefulness of magnetic resonance angiography (MRA) and magnetic resonance angiography perfusion (P-MR) in determining the risk of CC intolerance during CEA. Material and methods: 40 patients after CEA with CC intolerance were included in Group I, and 15 with CC tolerance in Group II. All patients underwent MRA of the circle of Willis (CoW), P-MR with or without Acetazolamide; P(A)-MR in the postoperative period. Results: CoW was normal in the MRA in three cases (7.5%) in Group I, and in eight (53%) in Group II. We found P-MR abnormalities in all patients from Group I and in 40% from Group II. Using a calculated cut-off point of 0.322, the patients were classified as CC tolerant with 100% sensitivity or as CC intolerant with 95% specificity. After evaluating P-MR or MRA alone, the percentage of false negative results significantly increased. Conclusion: The highest value in predicting cross-clamping intolerance is achieved by using analysis of P(A)-MR and MRA of the CoW in combination.Keywords
This publication has 27 references indexed in Scilit:
- Importance of Technical Preparation of Intraarterial Shunts to Prevent Iatrogenic Arterial Injury During Urgent ProceduresVascular and Endovascular Surgery, 2013
- Preoperative Magnetic Resonance Angiography as a Predictive Test for Cerebral Ischemia During Carotid EndarterectomyWorld Journal of Surgery, 2012
- Carotid Endarterectomy with Contralateral Carotid Occlusion: Is Shunting Necessary?International Journal of Angiology, 2012
- Shunting during carotid endarterectomyJournal of Vascular Surgery, 2011
- Distal Cervical Carotid Artery Dissection after Carotid Endarterectomy: A Complication of Indwelling ShuntInternational Journal of Vascular Medicine, 2010
- Prospective randomized trial of routine versus selective shunting in carotid endarterectomy based on stump pressureJournal of Vascular Surgery, 2010
- Predictors of shunt during carotid endarterectomy with routine electroencephalography monitoringJournal of Vascular Surgery, 2009
- Correlation of carotid artery stump pressure and neurologic changes during 474 carotid endarterectomies performed in awake patientsJournal of Vascular Surgery, 2005
- The value of phase-contrast magnetic resonance angiography of the circle of Willis in predicting cerebral ischemia-hypoxia (shunt need) during carotid endarterectomySurgical and Radiologic Anatomy, 2005
- The magnetic resonance Matas test: Feasibility and comparison with the conventional intraarterial balloon test occlusion with SPECT perfusion imagingJournal of Magnetic Resonance Imaging, 2005