Department of Neurosurgery, Inselspital, Bern University Hospital and University of Bern, 3010, Bern, Switzerland.
Department of Neuroradiology, Inselspital, Bern University Hospital and University of Bern, Bern, Switzerland.
Acta Neurochir (Wien). 2021 Jun;163(6):1799-1805. doi: 10.1007/s00701-020-04624-y. Epub 2020 Oct 24.
During carotid endarterectomy (CEA), significant amplitude decrement of somatosensory evoked potentials (SEPs) is associated with post-operative neurological deficits.
To investigate the association between an incomplete circle of Willis and/or contralateral ICA occlusion and subsequent changes in intra-operatively monitored SEPs.
We performed a retrospective analysis of a single center, prospective cohort of consecutive patients undergoing CEA over a 42-month period after reviewing the collateral arterial anatomy on pre-operative radiological imaging. The primary endpoint was an intra-operative decline in SEPs > 50% compared to the baseline value during arterial cross-clamping. Univariate and multivariate logistic regression analyses were performed to investigate a potential association between contralateral ICA occlusion, incomplete circle of Willis, and subsequent alteration in SEPs.
A total of 140 consecutive patients were included, of which 116 patients (82.9%) had symptomatic carotid stenosis of at least 50% according to the classification used in the North American Carotid Surgery Trial (NASCET) (Stroke 22:711-720, 1991). Six patients (4.3%) showed contralateral ICA occlusion, 22 patients (16%) a missing/hypoplastic anterior communicating artery (Acom) or A1 segment, and 79 patients (56%) a missing ipsilateral posterior communicating artery (Pcom) or P1 segment. ICA occlusion and missing segments of the anterior circulation (missing A1 and/or missing Acom) were associated with the primary endpoint (p = 0.003 and p = 0.022, respectively).
Contralateral ICA occlusion and missing anterior collaterals of the circle of Willis increase the risk of intra-operative SEP changes during CEA. Pre-operative assessment of collateral arterial anatomy might help identifying patients with an increased intra-operative risk.
在颈动脉内膜切除术（CEA）过程中，体感诱发电位（SEP）的显著幅度降低与术后神经功能缺损有关。
探讨不完整的 Willis 环和/或对侧颈内动脉闭塞与术中监测的 SEP 变化之间的关系。
我们对一个中心的前瞻性队列进行了回顾性分析，该队列在 42 个月的时间内连续接受了 CEA，回顾了术前影像学上的侧支动脉解剖结构。主要终点是在动脉夹闭过程中与基线值相比，SEP 术中下降超过 50%。进行单变量和多变量逻辑回归分析，以调查对侧颈内动脉闭塞、不完整的 Willis 环和随后 SEP 变化之间的潜在关联。
共纳入 140 例连续患者，其中 116 例（82.9%）根据北美颈动脉手术试验（NASCET）（Stroke 22：711-720，1991）使用的分类患有至少 50%的症状性颈动脉狭窄。6 例（4.3%）患者对侧颈内动脉闭塞，22 例（16%）患者前交通动脉（Acom）或 A1 段缺失/发育不良，79 例（56%）患者同侧后交通动脉（Pcom）或 P1 段缺失。颈内动脉闭塞和前循环缺失段（缺失 A1 和/或缺失 Acom）与主要终点相关（p=0.003 和 p=0.022）。
对侧颈内动脉闭塞和 Willis 环的前向侧支缺失增加了 CEA 期间术中 SEP 变化的风险。术前评估侧支动脉解剖结构可能有助于识别术中风险增加的患者。
