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. 2020 Dec 2;9(12):3913.
doi: 10.3390/jcm9123913.

The Anatomy of the Circle of Willis Is Not a Strong Enough Predictive Factor for the Prognosis of Cross-Clamping Intolerance during Carotid Endarterectomy

Piotr Myrcha  1   2 , Andrzej Lewczuk  3 , Maciej Jakuciński  4 , Mariusz Kozak  2 , Dawid Siemieniuk  2 , Dorota Różański  5 , Dariusz Koziorowski  5 , Witold Woźniak  1   2
Affiliations

The Anatomy of the Circle of Willis Is Not a Strong Enough Predictive Factor for the Prognosis of Cross-Clamping Intolerance during Carotid Endarterectomy

Piotr Myrcha et al. J Clin Med. .

Abstract

Carotid endarterectomy (CEA) is safe and effective in reducing the risk of stroke in symptomatic severe carotid artery stenosis. Having information about cross-clamping (CC) intolerance before surgery may reduce the complication rate. The purpose of this study was to assess the usefulness of magnetic resonance angiography (MRA) and magnetic resonance angiography perfusion (P-MR) in determining the risk of CC intolerance during CEA.

Material and methods: 40 patients after CEA with CC intolerance were included in Group I, and 15 with CC tolerance in Group II. All patients underwent MRA of the circle of Willis (CoW), P-MR with or without Acetazolamide; P(A)-MR in the postoperative period.

Results: CoW was normal in the MRA in three cases (7.5%) in Group I, and in eight (53%) in Group II. We found P-MR abnormalities in all patients from Group I and in 40% from Group II. Using a calculated cut-off point of 0.322, the patients were classified as CC tolerant with 100% sensitivity or as CC intolerant with 95% specificity. After evaluating P-MR or MRA alone, the percentage of false negative results significantly increased.

Conclusion: The highest value in predicting cross-clamping intolerance is achieved by using analysis of P(A)-MR and MRA of the CoW in combination.

Keywords: carotid endarterectomy; carotid magnetic resonance imaging; cerebrovascular disease/stroke; cross-clamping intolerance; magnetic resonance perfusion.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Arteries of the circle of Willis considered when calculating the W index. ACA—anterior cerebral artery, PCA—posterior cerebral artery, BA—basilar artery, AcoA—anterior communicating artery, PCoA—posterior communicating artery, MCA—middle cerebral artery, ICA—internal carotid artery, A1—1st segment of anterior cerebral artery, A2—2nd segment of anterior cerebral artery, P1—1st segment of posterior cerebral artery, P2—2nd segment of posterior cerebral artery.
Figure 2
Figure 2
ROC analysis—a model using the magnetic resonance brain perfusion with acetazolamide and magnetic resonance angiography of the intracranial arteries. ROC curve for the prediction variable (by cross-clamping test results).
Figure 3
Figure 3
Magnetic resonance brain perfusion with Acetazolamide and magnetic resonance angiography of the intracranial arteries. Right internal carotid artery—100%, left internal carotid artery—70%. Differences after admission of Acetazolamide marked with circles (right side).
Figure 4
Figure 4
Magnetic resonance brain perfusion with Acetazolamide and magnetic resonance angiography of the intracranial arteries. Right internal carotid artery—70%, left internal carotid artery—90% (operated side). Differences after admission of Acetazolamide marked with circles (right side).
See this image and copyright information in PMC

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