Gyöngyösi Zoltán, Belán Ivett, Nagy Edit, Fülesdi Zsófia, Farkas Orsolya, Végh Tamás, Hoksbergen Arjan Willem, Fülesdi Béla
Department of Anesthesiology and Intensive Care, University of Debrecen, Debrecen, Hungary.
Department of Radiology, University of Debrecen, Debrecen, Hungary.
Transl Neurosci. 2023 Jul 10;14(1):20220293. doi: 10.1515/tnsci-2022-0293. eCollection 2023 Jan 1.
The role of the willisian collaterals during carotid endarterectomies (CEAs) is a debated issue. The aim of the present work was to test whether an incomplete or non-functional circle of Willis (CoW) is a risk factor for ischemic events during CEA.
CEAs were performed under local anesthesia. Patients were considered symptomatic (SY) if neurological signs appeared after the cross-clamping phase. In SY patients shunt insertion was performed. CoW on CT angiograms (CTa) were analyzed offline and categorized as non-functional (missing or hypoplastic collaterals) or functional collaterals by three neuroradiologists. Near-infrared spectroscopy (NIRS) was performed throughout the procedure.
Based on CTa, 67 incomplete circles were found, 54 were asymptomatic (ASY) and 13 were SY. No complete CoW was found among the SY patients. Significant differences could be detected between incomplete and complete circles between ASY and SY groups (Chi-square: 6.08; = 0.013). The anterior communicating artery was missing or hypoplastic in 5/13 SY cases. There were no cases of the non-functional anterior communicating arteries in the ASY group (Chi-square: 32.9; = 10). A missing or non-functional bilateral posterior communicating artery was observed in 9/13 SY and in 9/81 ASY patients (Chi-square: 24.4; = 10). NIRS had a sensitivity of 76.9% and a specificity of 74.5% in detecting neurological symptoms.
Collateral ability of the CoW may be a risk factor for ischemic events during CEAs. Further studies should delineate whether the preoperative assessment of collateral capacity may be useful in decision-making about shunt use during CEA.
在颈动脉内膜切除术（CEA）过程中，Willis环侧支循环的作用是一个存在争议的问题。本研究的目的是检验Willis环（CoW）不完整或功能不全是否是CEA期间缺血事件的危险因素。
CEA在局部麻醉下进行。如果在夹闭阶段后出现神经体征，则患者被视为有症状（SY）。对于有症状的患者，进行分流管置入。对CT血管造影（CTa）上的CoW进行离线分析，并由三位神经放射科医生将其分类为功能不全（侧支循环缺失或发育不良）或功能正常的侧支循环。在整个手术过程中进行近红外光谱（NIRS）监测。
基于CTa，发现67个不完整的环，其中54个无症状（ASY），13个有症状（SY）。在有症状的患者中未发现完整的CoW。无症状组和有症状组中不完整环与完整环之间存在显著差异（卡方检验：6.08；P = 0.013）。在13例有症状的病例中，5例前交通动脉缺失或发育不良。无症状组中没有前交通动脉功能不全的病例（卡方检验：32.9；P = 0.0001）。在13例有症状患者中的9例以及81例无症状患者中的9例中观察到双侧后交通动脉缺失或功能不全（卡方检验：24.4；P = 0.0001）。NIRS检测神经症状的敏感性为76.9%，特异性为74.5%。
CoW的侧支循环能力可能是CEA期间缺血事件的危险因素。进一步的研究应明确术前评估侧支循环能力是否有助于在CEA期间关于分流管使用的决策制定。
