Key result
Patency of the anterior and bilateral posterior communicating arteries was associated with an 18.2-fold increased likelihood of tolerating the carotid cross-clamping test during endarterectomy.
Why the study?
The success of carotid endarterectomy relies on reducing procedural complications, making prior understanding of Circle of Willis anatomy crucial to prevent complications.
Does preoperative assessment of Circle of Willis anatomy predict tolerance to carotid cross-clamping and safety in patients undergoing carotid endarterectomy?
Cross-Sectional (n=69)
No
Does preoperative assessment of Circle of Willis anatomy predict tolerance to carotid cross-clamping and safety in patients undergoing carotid endarterectomy?
Odds Ratio: 18.2 (95% CI 2.789–370.72)
p-value: p=0.026
Preoperative assessment of the Circle of Willis anatomy via MRA can identify patients at high risk for carotid cross-clamping intolerance and perioperative complications during carotid endarterectomy.
May aid shunt decisions in carotid endarterectomy; leaves open prospective validation before practice change.
The success of carotid endarterectomy, an effective surgery in managing carotid stenosis, relies on reducing procedure complications. Therefore, prior understanding of the anatomy of the Circle of Willis is crucial to prevent complications. Objective: To evaluate the anatomy of the Circle of Willis to determine the safety of endarterectomy in patients with carotid stenosis. Methodology: A retrospective study in patients aged 18 or older with carotid stenosis indicating endarterectomy. Descriptive analysis, chi-square test, and Fisher's exact test were performed, adopting a significance level of p < 0.05. Results: A total of 69 patients were evaluated, with an average age of 68.48 years; males represented 59.4% (n=41) of the sample, and 4.3% (n=3) did not tolerate the carotid artery cross-clamping test. Patients with patency of the anterior communicating artery and posterior communicating arteries were 18.2 times more likely to tolerate the cross-clamping test (p=0.026; 95% CI: 2.789-370.720). Conclusion: The results of this study demonstrate that carotid endarterectomy is safe. In the evaluation of the Circle of Willis anatomy, it was evident that patients with an absent anterior communicating artery and absent posterior communicating arteries had a higher risk of carotid artery cross-clamping test intolerance, and the absence of the anterior communicating artery was associated with occurrences of complications in CEA. These findings emphasize the importance of assessing Circle of Willis anatomy preoperatively to determine the safety of the procedure.
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Ferreira et al. (2024) conducted a cross-sectional in Carotid stenosis (n=69). Patency of anterior and posterior communicating arteries vs. Absence of anterior and/or posterior communicating arteries was evaluated on Tolerance to the carotid cross-clamping test (OR 18.2, 95% CI 2.789-370.720, p=0.026). Patency of the anterior and bilateral posterior communicating arteries was associated with an 18.2-fold increased likelihood of tolerating the carotid cross-clamping test during endarterectomy.
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