PDF(Pubmed)
Abstract：
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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; p = 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; p = 10-8). 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; p = 10-7). NIRS had a sensitivity of 76.9% and a specificity of 74.5% in detecting neurological symptoms.
UNASSIGNED: 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.
UNASSIGNED: 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.
UNASSIGNED: 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; p = 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; p = 10-8). 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; p = 10-7). NIRS had a sensitivity of 76.9% and a specificity of 74.5% in detecting neurological symptoms.
UNASSIGNED: 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.
摘要：
■在颈动脉内膜切除术（CEA）中，威廉侧支的作用是一个有争议的问题。本工作的目的是测试不完整或无功能的Willis环（CoW）是否是CEA期间缺血事件的危险因素。
■在局部麻醉下进行CEA。如果在交叉钳夹阶段后出现神经系统症状，则认为患者有症状（SY）。在SY患者中，进行了分流插入。CT血管造影照片（CTa）上的CoW进行了离线分析，并由三名神经放射学家将其归类为非功能性（缺失或发育不良）或功能性侧支。在整个过程中进行近红外光谱(NIRS)。
■基于CTa，发现了67个不完整的圆圈，54人无症状(ASY)，13人SY。在SY患者中未发现完全CoW。在ASY和SY组之间的不完整和完整圆之间可以检测到显著差异(卡方:6.08;p=0.013)。5/13SY患者前交通动脉缺失或发育不良。ASY组没有出现无功能的前交通动脉（卡方：32.9；p=10-8）。在9/13SY和9/81ASY患者中观察到双侧后交通动脉缺失或无功能（卡方：24.4；p=10-7）。NIRS在检测神经系统症状方面的敏感性为76.9％，特异性为74.5％。
■CoW的侧支能力可能是CEA期间缺血事件的危险因素。进一步的研究应描述术前评估侧支容量是否对CEA期间的分流使用决策有用。
■在局部麻醉下进行CEA。如果在交叉钳夹阶段后出现神经系统症状，则认为患者有症状（SY）。在SY患者中，进行了分流插入。CT血管造影照片（CTa）上的CoW进行了离线分析，并由三名神经放射学家将其归类为非功能性（缺失或发育不良）或功能性侧支。在整个过程中进行近红外光谱(NIRS)。
■基于CTa，发现了67个不完整的圆圈，54人无症状(ASY)，13人SY。在SY患者中未发现完全CoW。在ASY和SY组之间的不完整和完整圆之间可以检测到显著差异(卡方:6.08;p=0.013)。5/13SY患者前交通动脉缺失或发育不良。ASY组没有出现无功能的前交通动脉（卡方：32.9；p=10-8）。在9/13SY和9/81ASY患者中观察到双侧后交通动脉缺失或无功能（卡方：24.4；p=10-7）。NIRS在检测神经系统症状方面的敏感性为76.9％，特异性为74.5％。
■CoW的侧支能力可能是CEA期间缺血事件的危险因素。进一步的研究应描述术前评估侧支容量是否对CEA期间的分流使用决策有用。
