The circle of Willis predicts the antihypertensive effects of carotid artery stenting

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Carotid artery stenting (CAS) has antihypertensive effects, but the durability and degree of this response remain variable. The authors propose that this clinical variability is a function of the presence or absence of a complete circle of Willis (COW). Incomplete COWs perfuse through a higher-resistance pial collateral pathway, and therefore patients may require a higher mean arterial pressure (MAP). Carotid artery revascularization in these patients would reduce the end-organ collateral demand that has been hypothesized to drive the MAP response.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Using a retrospective, nonrandomized within-subject case-control design, the authors compared the postoperative effects of CAS in patients with and without a complete COW by using changes in MAP and antihypertensive medication as end points. They recorded MAP and antihypertensive medications 3 months prior to surgery, preoperatively, immediately postoperatively, and at the 3-month follow-up.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Data were collected from 64 consecutive patients undergoing CAS. Patients without a complete COW (25%) were more likely to demonstrate a decrease in BP response to stenting (i.e., a drop in MAP of 10 mm Hg and/or a reduction or cessation of BP medications at 3 months postoperatively). Of the patients in the incomplete COW cohort, 75% had this outcome, whereas of those in the complete COW cohort, only 41% had it (p &lt; 0.041). These findings remained statistically significant in a logistic regression analysis for possible confounders (p &lt; 0.024). A receiver operating curve analysis of preoperative data indicated that a MAP &gt; 96.3 mm Hg was 55.5% sensitive and 57.4% specific for predicting a complete COW and that patients with a MAP &gt; 96.3 mm Hg were more likely to demonstrate a good MAP decrease following CAS (p &lt; 0.0092).</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>CAS is associated with a significant decrease in MAP and/or a reduction/cessation in BP medications in patients in whom a complete COW is absent.</jats:p></jats:sec>

The dynamics of blood pressure within 12 months after carotid artery stenting in patients with stenotic carotid lesions

“…наблюдения (p<0,027). При многофакторном анализе было показано, что 39 пациентов из 45 были с разобщенным Виллизиевым кругом, что являлось достоверным фактором снижения АД в отдаленном периоде после КАС (ОШ =10,37, 95% ДИ, от 3,64 до 29,52; p <0,001), что также подтверждено в исследовании Santiago-Dieppa DR, et al [18].…”