Independent role of circle of Willis for peri-procedural evaluation of carotid endarterectomy in patients with severe carotid stenosis

Although carotid endarterectomy (CEA) is now widely accepted as the surgical therapy for carotid stenosis, the role of and indications and evidence for many pharmacologic agents that are used adjunctively in the perioperative setting have not been conclusively established. Aspirin (acetylsalicylic acid) is the pharmaceutical agent that has been studied most extensively in conjunction with CEA; other than aspirin and dextran, the use of many agents before, during, and after CEA has not been standardized. Prospective randomized trials are still needed to demonstrate efficacy, predict outcome, and determine the optimal use of these medications in their adjunctive use during CEA to improve patient care and obtain optimal surgical outcomes.

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Carotid endarterectomy in patients with foetal-type posterior circle of Willis: Is there an indication for local anaesthesia?

VASA ◽

10.1024/0301-1526/a000138 ◽

2011 ◽

Vol 40 (5) ◽

pp. 404-407

Author(s):

Maras ◽

Tzormpatzoglou ◽

Papas ◽

Papanas ◽

Kotsikoris ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Local Anaesthesia ◽

Anatomical Variation ◽

Anatomical Variations ◽

Circle Of Willis ◽

Variable Degree ◽

Operative Complications ◽

The Right ◽

Ica Stenosis ◽

Symptomatic Stenosis

Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.

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Faculty Opinions recommendation of Contemporary results of carotid endarterectomy for asymptomatic carotid stenosis.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.7190958.7433060 ◽

2010 ◽

Author(s):

Veronika Skvortsova ◽

Vladimir Lelyuk

Keyword(s):

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid

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Outcome after carotid endarterectomy for asymptomatic carotid stenosis

Surgical Neurology ◽

10.1016/0090-3019(94)90005-1 ◽

1994 ◽

Vol 41 (6) ◽

pp. 443-449 ◽

Cited By ~ 3

Author(s):

Richard B. Libman ◽

Ralph L. Sacco ◽

Tianying Shi ◽

James W. Correll ◽

J.P. Mohr

Keyword(s):

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Asymptomatic Carotid Stenosis ◽

Asymptomatic Carotid

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High Intensity Transient Signals in Patients with Carotid Stenosis May Persist after Carotid Endarterectomy

Cerebrovascular Diseases ◽

10.1159/000075780 ◽

2003 ◽

Vol 17 (2-3) ◽

pp. 123-127 ◽

Cited By ~ 3

Author(s):

Kazumi Kimura ◽

Jacinda L. Stork ◽

Christopher R. Levi ◽

Anne L. Abbott ◽

Geoffrey A. Donnan ◽

...

Keyword(s):

Carotid Endarterectomy ◽

Carotid Stenosis ◽

High Intensity ◽

Transient Signals

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Endovascular Advances for Extracranial Carotid Stenosis

Neurosurgery ◽

10.1227/neu.0000000000000223 ◽

2014 ◽

Vol 74 (suppl_1) ◽

pp. S92-S101 ◽

Cited By ~ 1

Author(s):

Jorge L. Eller ◽

Travis M. Dumont ◽

Grant C. Sorkin ◽

Maxim Mokin ◽

Elad I. Levy ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Stenosis ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Carotid Stenting ◽

Historical Background ◽

Treatment Modalities ◽

Endovascular Management ◽

The Past

Abstract Carotid artery stenting has become a viable alternative to carotid endarterectomy in the management of carotid stenosis. Over the past 20 years, many trials have attempted to compare both treatment modalities and establish the indications for each one, depending on clinical and anatomic features presented by patients. Concurrently, carotid stenting techniques and devices have evolved and made endovascular management of carotid stenosis safe and effective. Among the most important innovations are devices for distal and proximal embolic protection and new stent designs. This paper reviews these advances in the endovascular management of carotid artery stenosis within the context of the historical background.

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