The value and limitations of magnetic resonance angiography of the circle of Willis in patients undergoing carotid endarterectomy

DePippo, Patrick; Ascher, Enrico; Scheinman, Marcel; Yorkovich, William; Hingorani, Anil

doi:10.1016/s0967-2109(98)00096-9

Cited by 18 publications

(9 citation statements)

References 22 publications

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“…This finding is in agreement with those reported by DePippo and colleagues. 28 Contrary to the report by Self and colleagues, 23 we did not find shunt use to be a predictor of post-CEA hematoma formation. Our study also did not find the use of shunt to be associated with an increased risk of cranial nerve palsy, as reported by Forssell and colleagues.…”

Section: Discussioncontrasting

confidence: 95%

Selective Shunting during Carotid Endarterectomy

2005

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Carotid endarterectomy (CEA) is an effective treatment for significant carotid atherosclerosis. Perioperative stroke, a devastating complication, may be partially circumvented by shunting. However, routine shunt use is not without complications and does not benefit every patient. Our study is designed to determine whether CEA under general anesthesia, without cerebral monitoring, can be safely done with shunting only in the presence of poor internal carotid artery back-bleeding or contralateral carotid occlusion or critical stenosis. The medical records of 995 carotid operations were reviewed. A subset of 117 operations was performed on 112 patients using selective shunting. Data were analyzed and outcomes compared. For the selective shunt group, indications for redo operations (n=13) were recurrent asymptomatic high-grade stenosis in 69% and amaurosis fugax or transient ischemic attack in 31%. Indications for primary CEA (n=104) were asymptomatic high-grade stenosis in 59%, amaurosis fugax or transient ischemic attack in 36%, previous stroke in 3%, and global ischemia in 2%. A selective shunt was used in 29% of all symptomatic and 11% of all asymptomatic patients. No cerebral monitoring was used. There were no perioperative deaths and no permanent cranial nerve injuries, and there was one stroke (0.8%) from postoperative carotid thrombosis in a shunted patient. The average length of stay was 1.6 days for the non-shunt group and 2.2 days for the shunt group. The routine shunt group (n=878) had an overall stroke rate of 0.7%, no permanent cranial nerve deficits, and a mean hospital stay of 2.6 days. CEA under general anesthesia with selective shunting can be performed safely without cerebral monitoring.

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Section: Discussioncontrasting

confidence: 95%

Selective Shunting during Carotid Endarterectomy

2005

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“…Our results suggest that if an ipsilateral PCoA is visible in CTA, in addition to present anterior segments, it may give sufficient collateral activation to avoid the need for shunting. This was in line with previous associations between an absent collateral support via PCoA and ACoA, and a higher frequency of shunt insertions (DePippo et al, 1999;Schneider et al, 1988;Schwartz et al, 1992;Wain et al, 1999). For patients with an absent PCoA, our stump pressures ranged between 40 and 60 mmHg, i.e., around the critical limit for shunt need, indicating that the CFD simulation may be useful in surgical planning.…”

Section: Difference In Pressure Between Anatomical Variations Of the ...supporting

confidence: 90%

“…The stump pressure has been suggested to result from the presence and size of ACoA or PCoA, degree of contralateral ICA stenosis, and mean arterial pressure (DePippo et al, 1999;Schneider et al, 1988;Wang et al, 2016). We found higher stump pressures in patients with a present ipsilateral PCoA than in those where it was absent.…”

Section: Difference In Pressure Between Anatomical Variations Of the ...mentioning

confidence: 46%

Prediction of cerebral perfusion pressure during carotid surgery – A computational fluid dynamics approach

Holmgren

Holmlund

Støverud

et al. 2022

Clinical Biomechanics

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“…27 However, MRA does not allow an adequate prediction of intraoperative perfusion because it only gives a static picture. 28 The information provided by selective intra-arterial angiographies in combination with the unique setting of local anaesthesia to evaluate the prognostic value of cross-flow cannot be replaced by MRA alone.…”

Section: Limitations Of Angiographymentioning

confidence: 99%