The Carotid Compression Test for Therapeutic Occlusion of the Internal Carotid Artery

Hetzel, Andreas; Reutern, G. M. von; Wernz, M.; Droste, Dirk W.; Schumacher, M.

doi:10.1159/000016056

Cited by 37 publications

(15 citation statements)

References 15 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…These studies showed that the collateral function of the circle of Willis can predict the tolerance of ICA occlusion. 29,30 In conclusion, in patients with unilateral ICA stenosis, the anatomic features and collateral flow patterns of the circle of Willis normalized after CEA. It may be presumed that these potential collaterals again become clinically significant when asymmetries between the flow in the 2 carotids become present, eg, when a restenosis occurs.…”

Section: Discussionmentioning

confidence: 79%

Effect of Carotid Endarterectomy on Primary Collateral Blood Flow in Patients With Severe Carotid Artery Lesions

Hendrikse

Rutgers

Klijn

et al. 2003

Stroke

View full text Add to dashboard Cite

Background and Purpose-In patients with severe obstruction of the internal carotid artery (ICA), it is recognized that the preoperative failure to visualize collaterals of the circle of Willis increases the risk of hemispheric ischemia before, during, and after carotid endarterectomy (CEA). The purpose of the present study was to assess the effect of CEA on the anatomy and function of the circle of Willis. Methods-Time-of-flight and phase-contrast MR angiography were used to study changes in vessel diameter and collateral flow of the circle of Willis in 48 patients with 70% to 99% ICA stenosis before and after CEA. Results-In patients with unilateral ICA stenosis, all preoperative vessel diameters on both sides of the circle of Willis were larger than in control subjects. All demonstrated a significant diameter decrease to reach normal values after CEA. Furthermore, preoperative collateral flow patterns normalized after CEA (Pϭ0.03). In patients with stenosis and contralateral ICA occlusion, CEA resulted in a significant increase in the prevalence of collateral flow via the anterior communicating artery (33% to 83%, PϽ0.01) and a significant increase in diameter of both A1 segments (PϽ0.05) in patients in whom collateral flow developed after CEA. Conclusions-CEA reduces the caliber of compensatory collateral channels to normal levels by MR angiography measurements in the presence of severe unilateral stenosis; when the opposite side is occluded and the stenosis is removed ipsilaterally, a greater amount of compensatory collateral circulation can be measured on both the occluded side and the fully opened side.

show abstract

Section: Discussionmentioning

confidence: 79%

Effect of Carotid Endarterectomy on Primary Collateral Blood Flow in Patients With Severe Carotid Artery Lesions

Hendrikse

Rutgers

Klijn

et al. 2003

Stroke

View full text Add to dashboard Cite

show abstract

“…This is a highly sensitive and specific method to test the collateral potential of the anterior (AcoA) and posterior (PcoA) communicating arteries: 98 and 100% for the AcoA and 84 and 94% for the PcoA, respectively [17, 18, 19]. Furthermore, we investigated by means of a case-control study, whether nonfunctioning collateral pathways in the circle of Willis are a risk factor for ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

Absent Collateral Function of the Circle of Willis as Risk Factor for Ischemic Stroke

et al. 2003

View full text Add to dashboard Cite

Background: Autopsy studies show a higher prevalence of circle of Willis anomalies in brains with signs of ischemic infarction. Our goal was to examine the collateral function of the circle of Willis in ischemic stroke patients and to assess in a case-control study if a collateral deficient circle of Willis is a risk factor for ischemic stroke in patients with severe internal carotid artery (ICA) occlusive disease. Methods: Our case-control study included 109 patients with an acute ischemic stroke in the anterior circulation and 113 patients with peripheral arterial disease and no known history of cerebral ischemia. The collateral function of the anterior and posterior communicating arteries of the circle of Willis was assessed by means of transcranial color-coded duplex ultrasonography (TCCD) and carotid compression tests. Results: TCCD was successfully performed in 75 case patients (mean age 64 years, range 41–91 years) and in 100 control patients (mean age 61 years, range 35–89 years). In 26 cases and 19 controls, a ≧70% stenosis or occlusion of the ICA was found. A nonfunctional anterior collateral pathway in the circle of Willis was found in 33% of the cases and in 6% of the controls (p < 0.001). The posterior collateral pathway was nonfunctional in 57% of the cases and in 43% of the controls (p = 0.02). In patients with severe ICA occlusive disease, the odds ratios of a nonfunctional anterior and a nonfunctional posterior collateral pathway were 7.33 (95% confidence interval, CI, = 1.19–76.52) and 3.00 (95% CI = 0.77–12.04), respectively. Conclusions: Patients who suffer ischemic stroke in the anterior circulation have a higher incidence of collateral deficient circles of Willis than those with atherosclerotic vascular disease without ischemic cerebrovascular disease. The presence of a nonfunctional anterior collateral pathway in the circle of Willis in patients with severe ICA occlusive disease is strongly associated with ischemic stroke.

show abstract

“…Giller et al [22] suggested a 65% decrement as tolerance threshold in patients undergoing carotid ligation for different neurosurgical procedures. Likewise, Hetzel et al [23], in a similar setting, identified a 60% decrement as the lower safety limit. Although in our cases the threshold suggested by the ROC curve was also 61%, we raised it to 85% to increase the PPV and specificity at the expenses of sensitivity and the NPV, but with an overall increase in accuracy from 80 to 87%.…”

Section: Discussionmentioning

confidence: 96%

Predictors of Carotid Clamping Intolerance during Endarterectomy That Would Be Wise to Apply to Stenting Procedures

Anzola

Limoni²,

Cavrini³

2008

Cerebrovasc Dis

View full text Add to dashboard Cite

Background and Purpose: Carotid artery stenting procedures are increasingly being performed with devices such as the MO.MA or the Parodi system that involve endovascular clamping of the common carotid artery, thus exposing the ipsilateral hemisphere to the risk of hypoperfusion. The aim of the present study was to look for predictors of carotid clamping intolerance by means of transcranial Doppler. Patients and Methods: We analysed the findings of an earlier Italian multicentre prospective study (SCITEA, Italian Cooperative Study of Transcranial Doppler in Carotid Endarterectomy) in which 513 consecutive patients (males/females 397/116, mean age 67 ± 7 years, mean carotid stenosis 81 ± 11%, NASCET method) scheduled to undergo carotid endarterectomy had been investigated non-invasively with transcranial Doppler, and we correlated the data obtained preoperatively with the need to insert a shunt during surgery as an index of intolerance to carotid clamping. Results: Four hundred and thirty-nine patients (85.6%) underwent surgery without and 74 (14.4%) with the insertion of a shunt. Patients who needed a shunt (intolerant) had a significantly higher decrement in mean flow velocity in the ipsilateral middle cerebral artery (MCA) after compression of the ipsilateral common carotid artery (71.8 ± 22 vs. 30.6 ± 24%) and were significantly more likely to have non-recruitable collateral pathways (75 vs. 18%). Logistic regression analysis confirmed that an MCA decrement of >85% (p = 0.005) and no potential collateralization (p = 0.011) were independent predictors of clamping intolerance. Combining the results of both compression tests (MCA decrement and collateral recruitment) yielded a sensitivity of 64%, a specificity of 99%, a positive predicted value of 88%, a negative predicted value of 95% and an overall accuracy of 95% in predicting shunt insertion. Conclusions: The preoperative assessment of recruitable collaterals and of maximal decrement in MCA mean flow velocity after carotid compression are useful predictors of carotid clamping intolerance. The criteria derived from carotid endarterectomy need to be applied and validated in a prospective series of patients undergoing carotid artery stenting procedures.

show abstract

The Carotid Compression Test for Therapeutic Occlusion of the Internal Carotid Artery

Cited by 37 publications

References 15 publications

Effect of Carotid Endarterectomy on Primary Collateral Blood Flow in Patients With Severe Carotid Artery Lesions

Effect of Carotid Endarterectomy on Primary Collateral Blood Flow in Patients With Severe Carotid Artery Lesions

Absent Collateral Function of the Circle of Willis as Risk Factor for Ischemic Stroke

Predictors of Carotid Clamping Intolerance during Endarterectomy That Would Be Wise to Apply to Stenting Procedures

Contact Info

Product

Resources

About