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Abstract：
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.
摘要：
本文旨在探讨无症状颈动脉狭窄患者围手术期缺血性卒中风险评估的进展。当前术前诊断算法中基于CTA或MR诊断成像的Willis环（CoW）形态学研究。功能性经颅多普勒(FTCD),近红外光谱(NIRS),在评估脑血管储备能力和侧支血管系统的背景下，讨论了光学相干断层扫描血管造影（OCTA）。尤其是CoW。这些非侵入性诊断工具提供对脑灌注状态的额外有价值的见解。他们支持生物医学建模作为预测颈动脉狭窄对脑灌注血流动力学变化的潜在影响的金标准。术中风险评估策略，包括选择性分流，重点探讨CoW变化及其对围手术期缺血性卒中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通过降低围手术期缺血性神经系统事件的风险和预防进一步认知功能下降,支持临床决策并改善无症状患者结局的潜力.
