Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis

Overview

Journal J Clin Med

Specialty General Medicine

Date 2024 May 11

PMID 38731014

Authors

Balazs Lengyel

Rita Magyar-Stang

Hanga Pal

Robert Debreczeni

Agnes Dora Sandor

Andrea Szekely

Daniel Gyurki

Benjamin Csippa

Lilla Istvan

Illes Kovacs

Peter Sotonyi Jr

Zsuzsanna Mihaly

Affiliations

Soon will be listed here.

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.

References

Zhu J, Wang W, Shi H . The Association between Postoperative Cognitive Dysfunction and Cerebral Oximetry during Geriatric Orthopedic Surgery: A Randomized Controlled Study. Biomed Res Int. 2021; 2021:5733139. PMC: 8548108. DOI: 10.1155/2021/5733139. View

van der Grond J, de Leeuw F, de Groot J, Algra A, Hillen B, Breteler M . Circle of Willis: morphologic variation on three-dimensional time-of-flight MR angiograms. Radiology. 1998; 207(1):103-11. DOI: 10.1148/radiology.207.1.9530305. View

Varga A, Di Leo G, Banga P, Csobay-Novak C, Kolossvary M, Maurovich-Horvat P . Multidetector CT angiography of the Circle of Willis: association of its variants with carotid artery disease and brain ischemia. Eur Radiol. 2018; 29(1):46-56. PMC: 6291432. DOI: 10.1007/s00330-018-5577-x. View

Naylor R, Rantner B, Ancetti S, de Borst G, De Carlo M, Halliday A . Editor's Choice - European Society for Vascular Surgery (ESVS) 2023 Clinical Practice Guidelines on the Management of Atherosclerotic Carotid and Vertebral Artery Disease. Eur J Vasc Endovasc Surg. 2022; 65(1):7-111. DOI: 10.1016/j.ejvs.2022.04.011. View

Foret T, Guillaumin M, Desmarets M, Costa P, Rinckenbach S, Salomon du Mont L . Association between carotid revascularization for asymptomatic stenosis and cognitive functions. Vasa. 2022; 51(3):138-149. DOI: 10.1024/0301-1526/a000996. View

Xu P, Liu X, Zhang H, Ghista D, Zhang D, Shi C . Assessment of boundary conditions for CFD simulation in human carotid artery. Biomech Model Mechanobiol. 2018; 17(6):1581-1597. DOI: 10.1007/s10237-018-1045-4. View

Xiang Y, Huang X, Benitez Mendieta J, Wang J, Paritala P, Lloyd T . The Need to Shift from Morphological to Structural Assessment for Carotid Plaque Vulnerability. Biomedicines. 2022; 10(12). PMC: 9776071. DOI: 10.3390/biomedicines10123038. View

Zaninovich O, Ramey W, Walter C, Dumont T . Completion of the Circle of Willis Varies by Gender, Age, and Indication for Computed Tomography Angiography. World Neurosurg. 2017; 106:953-963. DOI: 10.1016/j.wneu.2017.07.084. View

Lee C, Cheng H, Chang F, Wang A . Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting. Sci Rep. 2019; 9(1):14755. PMC: 6791857. DOI: 10.1038/s41598-019-51382-8. View

10.

Aceto P, Lai C, De Crescenzo F, Crea M, Di Franco V, Pellicano G . Cognitive decline after carotid endarterectomy: Systematic review and meta-analysis. Eur J Anaesthesiol. 2019; 37(11):1066-1074. DOI: 10.1097/EJA.0000000000001130. View

11.

Succar B, Zhou W . Does Carotid Intervention Improve Cognitive Function?. Adv Surg. 2023; 57(1):267-277. DOI: 10.1016/j.yasu.2023.04.007. View

12.

Ritter J, Green D, Slim H, Tiwari A, Brown J, Rashid H . The role of cerebral oximetry in combination with awake testing in patients undergoing carotid endarterectomy under local anaesthesia. Eur J Vasc Endovasc Surg. 2011; 41(5):599-605. DOI: 10.1016/j.ejvs.2010.12.009. View

13.

Fudickar A, Peters S, Stapelfeldt C, Serocki G, Leiendecker J, Meybohm P . Postoperative cognitive deficit after cardiopulmonary bypass with preserved cerebral oxygenation: a prospective observational pilot study. BMC Anesthesiol. 2011; 11:7. PMC: 3068111. DOI: 10.1186/1471-2253-11-7. View

14.

Nishijima Y, Akamatsu Y, Yang S, Lee C, Baran U, Song S . Impaired Collateral Flow Compensation During Chronic Cerebral Hypoperfusion in the Type 2 Diabetic Mice. Stroke. 2016; 47(12):3014-3021. PMC: 5134912. DOI: 10.1161/STROKEAHA.116.014882. View

15.

Inciura D, Antusevas A, Aladaitis A, Gimzauskaite A, Velicka L, Kavaliauskiene Z . Near-infrared spectroscopy as a predictor of cerebral ischaemia during carotid endarterectomy in awake patients. Vascular. 2020; 28(3):301-308. DOI: 10.1177/1708538119893830. View

16.

Highton D, Elwell C, Smith M . Noninvasive cerebral oximetry: is there light at the end of the tunnel?. Curr Opin Anaesthesiol. 2010; 23(5):576-81. DOI: 10.1097/aco.0b013e32833e1536. View

17.

Helthuis J, van Doormaal T, Amin-Hanjani S, Du X, Charbel F, Hillen B . A patient-specific cerebral blood flow model. J Biomech. 2019; 98:109445. DOI: 10.1016/j.jbiomech.2019.109445. View

18.

Maguida G, Shuaib A . Collateral Circulation in Ischemic Stroke: An Updated Review. J Stroke. 2023; 25(2):179-198. PMC: 10250877. DOI: 10.5853/jos.2022.02936. View

19.

Banga P, Varga A, Csobay-Novak C, Kolossvary M, Szanto E, Oderich G . Incomplete circle of Willis is associated with a higher incidence of neurologic events during carotid eversion endarterectomy without shunting. J Vasc Surg. 2018; 68(6):1764-1771. DOI: 10.1016/j.jvs.2018.03.429. View

20.

Al-Sheikh M, Falavarjani K, Akil H, Sadda S . Impact of image quality on OCT angiography based quantitative measurements. Int J Retina Vitreous. 2017; 3:13. PMC: 5430594. DOI: 10.1186/s40942-017-0068-9. View