Bost Rianne B C, Hendrikse Jeroen, Algra Ale, de Borst Gert J, Kappelle Laurens Jaap, Jongen Lisa M, Brown Martin M, van der Worp Hendrik Bart
Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, Utrecht, The Netherlands.
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
J Stroke Cerebrovasc Dis. 2014 Apr;23(4):699-705. doi: 10.1016/j.jstrokecerebrovasdis.2013.06.020. Epub 2013 Jul 16.
In patients with internal carotid artery (ICA) stenosis, the circle of Willis (CoW) is the primary collateral pathway. We compared luminal diameters in the CoW before and after carotid revascularization and compared the effects of carotid endarterectomy (CEA) and stenting on these diameters.
At a single center in the International Carotid Stenting Study, 139 patients with symptomatic ICA stenosis of 50% or more were randomized to stenting (n = 81) or CEA (n = 58). The diameters of all segments of the CoW were assessed on computed tomography angiography (CTA), before and 30 days after revascularization. All evaluations were performed blinded to treatment allocation and order of CTA.
A .10-mm increase (95% confidence interval [CI], .02-.17; 7%; P = .01) in diameter after revascularization occurred in the ipsilateral precommunicating anterior cerebral artery (A1), whereas both the ipsilateral and contralateral posterior communicating arteries decreased in diameter by .12 mm (95% CI, .04-.21; 14%; P = .01) and .08 mm (95% CI, .00-.17; 10%; P = .05), respectively. The increase in diameter of the A1 was larger after stenting (.15 mm; 95% CI, .07-.24; P = .001) than after CEA (.02 mm; 95% CI, -.11 to .15; P = .79). Only in patients treated with CEA, the diameters of the contralateral A1 and ipsilateral precommunicating posterior cerebral artery were reduced after revascularization.
Carotid revascularization improves anterior collateralization and reduces reliance on posterior collateral pathways via the CoW. Carotid stenting and endarterectomy appear to have different early effects on collateralization.
在颈内动脉（ICA）狭窄患者中，Willis环（CoW）是主要的侧支循环途径。我们比较了颈动脉血运重建前后CoW的管腔直径，并比较了颈动脉内膜切除术（CEA）和支架置入术对这些直径的影响。
在国际颈动脉支架置入研究的一个中心，139例症状性ICA狭窄达50%或以上的患者被随机分为支架置入组（n = 81）或CEA组（n = 58）。在血运重建前及血运重建后30天，通过计算机断层血管造影（CTA）评估CoW所有节段的直径。所有评估均在对治疗分配和CTA顺序不知情的情况下进行。
血运重建后，同侧大脑前动脉交通前段（A1）直径增加0.10 mm（95%置信区间[CI]，0.02 - 0.17；7%；P = 0.01），而同侧和对侧后交通动脉直径分别减小0.12 mm（95% CI，0.04 - 0.21；14%；P = 0.01）和0.08 mm（95% CI，0.00 - .17；10%；P = 0.05）。支架置入术后A1直径增加幅度（0.15 mm；95% CI，0.07 - 0.24；P = 0.001）大于CEA术后（0.02 mm；95% CI， - 0.11至0.15；P = 0.79）。仅在接受CEA治疗的患者中，血运重建后对侧A1和同侧大脑后动脉交通前段直径减小。
颈动脉血运重建可改善前向侧支循环，减少通过CoW对后向侧支循环途径的依赖。颈动脉支架置入术和内膜切除术似乎对侧支循环有不同的早期影响。
