Vascular Surgery, Department of Surgical Sciences, Cagliari University, Cagliari, Italy.
Eur J Vasc Endovasc Surg. 2013 Feb;45(2):107-12. doi: 10.1016/j.ejvs.2012.11.012. Epub 2012 Dec 21.
During carotid endarterectomy (CEA), an intolerance to the cross-clamping (CC) can occur. The purpose of this study was to evaluate whether preoperative magnetic resonance angiography (MRA) can predict CC intolerance.
Seventy-one patients (57 males, 14 females, mean age 71.8 years, age range 46-86 years) underwent 71 CEA procedures under local anaesthesia. Before CEA, patients underwent an MRA of the Circle of Willis (CoW) and were then classified into three groups: group A consisted of patients with a complete CoW, group B included patients with one agenesia/obstruction in the CoW and group C comprised patients with two or more agenesiae/obstructions in the CoW. The association between the number of anatomical variants in the CoW, corrected for the status of the contralateral carotid artery, and the onset of CC intolerance was evaluated.
The prevalence of intolerance to CC was 15.5% (11/71). The Fisher test and logistic regression analysis showed a statistically significant association between the intolerance to CC and two or more agenesiae/obstructions in the CoW (p value < 0.00001 and p < 0.001, respectively). No neurological complications were observed.
The results of our study showed that two or more agenesiae/obstructions of the CoW identified by MRA were associated with a high risk of intolerance to CC during CEA.
在颈动脉内膜切除术（CEA）期间，可能会出现对夹闭（CC）的不耐受。本研究的目的是评估术前磁共振血管造影（MRA）是否可以预测 CC 不耐受。
71 例患者（57 例男性，14 例女性，平均年龄 71.8 岁，年龄范围 46-86 岁）在局部麻醉下进行了 71 例 CEA 手术。在 CEA 之前，患者接受了 Willis 环（CoW）的 MRA 检查，然后将其分为三组：A 组包括 CoW 完全存在的患者，B 组包括 CoW 存在单侧发育不全/阻塞的患者，C 组包括 CoW 存在两个或更多发育不全/阻塞的患者。评估 CoW 中解剖变异数量与 CC 不耐受发生之间的关系，校正对侧颈动脉的状态。
CC 不耐受的发生率为 15.5%（11/71）。Fisher 检验和逻辑回归分析显示，CC 不耐受与 CoW 中存在两个或更多发育不全/阻塞之间存在统计学显著关联（p 值<0.00001 和 p<0.001）。未观察到神经并发症。
我们的研究结果表明，MRA 识别的 CoW 中两个或更多发育不全/阻塞与 CEA 期间 CC 不耐受的高风险相关。
