Lengyel Balázs, Magyar-Stang Rita, Pál Hanga, Debreczeni Róbert, Sándor Ágnes Dóra, Székely Andrea, Gyürki Dániel, Csippa Benjamin, István Lilla, Kovács Illés, Sótonyi Péter, Mihály Zsuzsanna
Department of Vascular and Endovascular Surgery, Heart and Vascular Center, Semmelweis University, 1122 Budapest, Hungary.
Department of Neurology, Semmelweis University, 1085 Budapest, Hungary.
J Clin Med. 2024 Apr 24;13(9):2487. doi: 10.3390/jcm13092487.
This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.
本综述旨在探讨有显著颈动脉狭窄的无症状患者围手术期缺血性中风风险评估的进展，重点关注当前术前诊断算法中基于CTA或MR诊断成像的Willis环（CoW）形态。在评估脑血管储备能力和侧支血管系统，特别是CoW时，讨论了功能经颅多普勒（fTCD）、近红外光谱（NIRS）和光学相干断层扫描血管造影（OCTA）。这些非侵入性诊断工具为脑灌注状态提供了额外的有价值见解。它们支持生物医学建模，将其作为预测颈动脉狭窄对脑灌注血流动力学变化潜在影响的金标准。探讨了包括选择性分流在内的术中风险评估策略，重点关注CoW变异及其对围手术期缺血性中风和认知功能下降的影响。通过综合这些见解，本综述强调了非侵入性诊断方法在支持临床决策和通过降低围手术期缺血性神经事件风险及预防进一步认知衰退来改善无症状患者预后方面的潜力。
