Incomplete circle of Willis and cerebrovascular reactivity in asymptomatic patients before and after carotid endarterectomy

Introduction/Objective. Circle of Willis (CoW) provides the most significant collateral flow in the presence of significant stenosis or occlusion of internal carotid artery. In terms of collateral flow ?incomplete? type and ?complete? type of CoW can be recognized. Patients with carotid artery disease with incomplete CoW have lower cerebrovascular reactivity and higher risk for stroke. Cerebrovascular reactivity refers to the residual capacity of dilatation of cerebral blood vessels in the condition of insufficient blood flow. In this study we analyzed changes in cerebrovascular reactivity after carotid endarterectomy in asymptomatic patients with respect to complete and incomplete CoW morphology. Methods. In this study in 97 patients with asymptomatic carotid artery disease we measured cerebrovascular reactivity before and after carotid endarterectomy by using method of ?apnea test? and ? Breath Hold Index? (BHI). Patients were divided into two following groups: patients with ?complete? CoW and ?incomplete? CoW based on non-contrast magnetic resonance angio performed previously to the operation. Descriptive statistics, univariate analysis, and ANOVA for comparison of BHI values between groups were used. Results. Results showed significant increase in cerebrovascular reactivity at the side of stenosis in both groups of patients with complete CoW (BHI value increased from 0,897 to 1.090; F(1.65) = 30.788, p < 0.0005, parc. ?2 = 0.321) and incomplete CoW (BHI value increased from 0.690 to 1.010; F ( 1.27 ) = 62.318 , p < 0.0005, parc. ?2 = 0.698) and the more significant increase in the group of incomplete CoW compared to the group with complete CoW (F (1.92 ) = 4.557 , p =0.035 , parc. ?2 =0.047) Conclusion. In most asymptomatic patients, cerebrovascular reactivity restores to normal following carotid endarterectomy. Parameters of cerebrovascular reactivity are lower in patients with incomplete CoW and the increase after carotid endarterectomy is more significant in such patients.

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Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease

Journal of Cerebral Blood Flow & Metabolism ◽

10.1177/0271678x17724027 ◽

2017 ◽

Vol 38 (11) ◽

pp. 2021-2032 ◽

Cited By ~ 16

Author(s):

Nolan S Hartkamp ◽

Esben T Petersen ◽

Michael A Chappell ◽

Thomas W Okell ◽

Maarten Uyttenboogaart ◽

...

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Carotid Artery Disease ◽

Tissue Level ◽

Cerebrovascular Reactivity ◽

Collateral Flow ◽

Collateral Blood Flow ◽

Ischaemic Damage ◽

Before And After ◽

Artery Disease

Collateral blood flow plays a pivotal role in steno-occlusive internal carotid artery (ICA) disease to prevent irreversible ischaemic damage. Our aim was to investigate the effect of carotid artery disease upon cerebral perfusion and cerebrovascular reactivity and whether haemodynamic impairment is influenced at brain tissue level by the existence of primary and/or secondary collateral. Eighty-eight patients with steno-occlusive ICA disease and 29 healthy controls underwent MR examination. The presence of collaterals was determined with time-of-flight, two-dimensional phase contrast MRA and territorial arterial spin labeling (ASL) imaging. Cerebral blood flow and cerebrovascular reactivity were assessed with ASL before and after acetazolamide. Cerebral haemodynamics were normal in asymptomatic ICA stenosis patients, as opposed to patients with ICA occlusion, in whom the haemodynamics in both hemispheres were compromised. Haemodynamic impairment in the affected brain region was always present in symptomatic patients. The degree of collateral blood flow was inversely correlated with haemodynamic impairment. Recruitment of secondary collaterals only occurred in symptomatic ICA occlusion patients. In conclusion, both CBF and cerebrovascular reactivity were found to be reduced in symptomatic patients with steno-occlusive ICA disease. The presence of collateral flow is associated with further haemodynamic impairment. Recruitment of secondary collaterals is associated with severe haemodynamic impairment.

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Selection of Treatment for Patients with Carotid Artery Disease: Medication, Carotid Endarterectomy, or Carotid Artery Stenting

Vascular ◽

10.1258/rsmvasc.13.2.92 ◽

2005 ◽

Vol 13 (2) ◽

pp. 92-97 ◽

Cited By ~ 3

Author(s):

Marc Bosiers ◽

Patrick Peeters ◽

Koen Deloose ◽

Jürgen Verbist ◽

L. Richard Sprouse

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Medical Therapy ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Limiting Factors ◽

Treatment Modalities ◽

Asymptomatic Patients ◽

Artery Disease ◽

Selection Of

Patients presenting with atherosclerosis of the extracranial carotid arteries may be offered carotid endarterectomy (CEA), carotid artery stenting (CAS), or medical therapy to reduce their risk of stroke. In many cases, the choice between treatment modalities remains controversial. An algorithm based on patients' neurologic symptoms, comorbidities, limiting factors for CAS and CEA, and personal preferences was developed to determine the optimal treatment in each case. This algorithm was then employed to determine therapy in 308 consecutive patients presenting to a single institution during one calendar year. Ninety-five (30.8%) patients presented with an asymptomatic carotid stenosis of more than 80% and 213 (69.2%) with a symptomatic stenosis of more than 50%. According to our algorithm, 59 (62.1%) of the 95 asymptomatic patients received CAS, 20 (21.1%) received CEA, and 16 (16.8%) received medical therapy. All symptomatic patients underwent intervention; 153 (71.8%) were treated with CAS and 60 (28.2%) with CEA. Combined 30-day stroke and death rates after CAS were 1.7% in asymptomatic patients and 2.6% in symptomatic patients. After CEA, these rates were 0% and 3.3%, respectively. Careful selection of treatment modality according to predetermined criteria can result in improved outcomes.

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Neurocognitive functioning and cerebrovascular reactivity after carotid endarterectomy

Neurology ◽

10.1212/wnl.0000000000004862 ◽

2017 ◽

Vol 90 (4) ◽

pp. e307-e315 ◽

Cited By ~ 34

Author(s):

Simona Lattanzi ◽

Luciano Carbonari ◽

Gabriele Pagliariccio ◽

Marco Bartolini ◽

Claudia Cagnetti ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Cognitive Performance ◽

Carotid Artery Disease ◽

Cerebral Hemodynamics ◽

Cerebrovascular Reactivity ◽

Performance Change ◽

Complex Figure ◽

Artery Disease ◽

Ica Stenosis

ObjectiveTo evaluate in patients with TIA and ipsilateral high-grade internal carotid artery (ICA) stenosis whether changes in cognitive performance and cerebral hemodynamics occurred after carotid endarterectomy (CEA) and to explore their relationship.MethodsParticipants were patients who underwent CEA, had TIA within the last 6 months, and had an ipsilateral severe ICA stenosis. Coloured Progressive Matrices (CPM) plus Complex Figure Copy Test (CFCT) and phonemic (ph) plus categorical (ca) Verbal Fluency (VF) tests were performed to assess right and left hemisphere cognitive functions, respectively. Hemodynamics was assessed with transcranial Doppler ultrasonography by means of the cerebral vasomotor reactivity (CVR) to hypercapnia.ResultsA total of 137 patients were included. Before CEA, patients with right ICA obtained lower scores on the CPM and CFCT; patients with left ICA stenosis performed worse on the phonemic and categorical VF tests. The CVR was decreased on the side of the stenosis. At 6 months from CEA, CVR and cognitive performance were significantly improved. The performance change in cognitive tests exploring the revascularized hemisphere was positively associated with the ipsilateral CVR variation (CPM: R2 for linear regression = 0.759, adjR2 = 0.737; CFCT: R2 = 0.734, adjR2 = 0.710; (ph)VF: R2 = 0.774, adjR2 = 0.749; (ca)VF: R2 = 0.732, adjR2 = 0.703).ConclusionCognitive performance was enhanced at 6 months since CEA, and the improvement was related to the CVR increase. Cerebral hemodynamics may be an independent and potentially reversible determinant of cognitive dysfunction in severe carotid artery disease.

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Perfusion-weighted magnetic resonance imaging in patients with carotid artery disease before and after carotid endarterectomy

Journal of Vascular Surgery ◽

10.1067/mva.2001.118588 ◽

2001 ◽

Vol 34 (4) ◽

pp. 587-593 ◽

Cited By ~ 20

Author(s):

Arnd Doerfler ◽

Hans H. Eckstein ◽

Michael Eichbaum ◽

Sabine Heiland ◽

Thomas Benner ◽

...

Keyword(s):

Magnetic Resonance Imaging ◽

Magnetic Resonance ◽

Carotid Artery ◽

Carotid Endarterectomy ◽

Carotid Artery Disease ◽

Resonance Imaging ◽

Before And After ◽

Weighted Magnetic Resonance Imaging ◽

Artery Disease

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Evaluation of haemodynamic impairment and collateral flow in symptomatic carotid artery disease using arterial spin labelling MRI

Aktuelle Neurologie ◽

10.1055/s-2005-919686 ◽

2005 ◽

Vol 32 (S 4) ◽

Author(s):

R Kern ◽

M Günther ◽

F Sallustio ◽

K Szabo ◽

M Griebe ◽

...

Keyword(s):

Carotid Artery ◽

Carotid Artery Disease ◽

Arterial Spin Labelling ◽

Collateral Flow ◽

Symptomatic Carotid ◽

Artery Disease ◽

Spin Labelling

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The Current Status of Carotid Endarterectomy: The “Gold Standard” Treatment for Carotid Artery Disease

Journal of Vascular and Interventional Radiology ◽

10.1016/s1051-0443(97)70014-9 ◽

1997 ◽

Vol 8 (1) ◽

pp. 16-19

Author(s):

Bruce A. Perler

Keyword(s):

Carotid Artery ◽

Carotid Endarterectomy ◽

Gold Standard ◽

Standard Treatment ◽

Carotid Artery Disease ◽

Current Status ◽

Artery Disease

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Transcarotid Artery Revascularization and Advances in Vascular Surgery for Carotid Artery Disease

Surgical Technology Online ◽

10.52198/21.sti.39.cv1484 ◽

2021 ◽

Author(s):

James Hu ◽

◽

Andy Sohn ◽

Justin George ◽

Rajesh Malik ◽

...

Keyword(s):

Carotid Artery ◽

Vascular Surgery ◽

Carotid Endarterectomy ◽

Surgical Management ◽

Carotid Artery Stenosis ◽

Carotid Artery Stenting ◽

Carotid Artery Disease ◽

Artery Stenosis ◽

Cerebrovascular Accidents ◽

Artery Disease

Carotid artery atherosclerotic disease impacts over 2 million Americans annually. Since the advent of the carotid endarterectomy by Debakey in 1953, the surgical management of carotid artery stenosis has prevented cerebrovascular accidents. The technology utilized to manage carotid artery stenosis continued to evolve with the utilization of carotid artery stenting in 1989 and more recently transcarotid artery revascularization (TCAR). This review discusses the modern management of carotid artery stenosis with an emphasis on transcarotid artery revascularization (TCAR) and reversal of flow for reversal of flow for embolic protection.

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