Effects of Carotid Endarterectomy or Stenting on Arterial Diameters in the Circle of Willis

被引:11
作者
Bost, Rianne B. C. [1 ]
Hendrikse, Jeroen [2 ]
Algra, Ale [1 ,3 ]
de Borst, Gert J. [4 ]
Kappelle, Laurens Jaap [1 ]
Jongen, Lisa M. [2 ]
Brown, Martin M. [5 ]
van der Worp, Hendrik Bart [1 ]
机构
[1] Univ Med Ctr Utrecht, Rudolf Magnus Inst Neurosci, Dept Neurol & Neurosurg, NL-3508 GA Utrecht, Netherlands
[2] Univ Med Ctr Utrecht, Dept Radiol, NL-3508 GA Utrecht, Netherlands
[3] Univ Med Ctr Utrecht, Julius Ctr Hlth Sci & Primary Care, NL-3508 GA Utrecht, Netherlands
[4] Univ Med Ctr Utrecht, Dept Vasc Surg, NL-3508 GA Utrecht, Netherlands
[5] UCL, Inst Neurol, Dept Brain Repair & Rehabil, London, England
基金
英国医学研究理事会;
关键词
Stroke; circle of Willis; carotid endarterectomy; stents; randomized clinical trials; COLLATERAL CIRCULATION; COMMUNICATING ARTERY; CEREBRAL PERFUSION; BLOOD-FLOW; STENOSIS; RISK; STROKE; ANGIOGRAPHY; OCCLUSION; ANATOMY;
D O I
10.1016/j.jstrokecerebrovasdis.2013.06.020
中图分类号
Q189 [神经科学];
学科分类号
071006 ;
摘要
Background: In patients with internal carotid artery (ICA) stenosis, the circle of Willis (CoW) is the primary collateral pathway. We compared luminal diameters in the CoW before and after carotid revascularization and compared the effects of carotid endarterectomy (CEA) and stenting on these diameters. Methods: At a single center in the International Carotid Stenting Study, 139 patients with symptomatic ICA stenosis of 50% or more were randomized to stenting (n = 81) or CEA (n = 58). The diameters of all segments of the CoW were assessed on computed tomography angiography (CTA), before and 30 days after revascularization. All evaluations were performed blinded to treatment allocation and order of CTA. Results: A .10-mm increase (95% confidence interval [CI], .02-.17; 7%; P = .01) in diameter after revascularization occurred in the ipsilateral precommunicating anterior cerebral artery (A1), whereas both the ipsilateral and contralateral posterior communicating arteries decreased in diameter by. 12 mm(95% CI, .04-.21; 14%; P = .01) and .08 mm(95% CI, .00-.17; 10%; P = .05), respectively. The increase in diameter of the A1 was larger after stenting (.15 mm; 95% CI, .07-.24; P = .001) than after CEA (.02 mm; 95% CI, 2.11 to.15; P = .79). Only in patients treated with CEA, the diameters of the contralateral A1 and ipsilateral precommunicating posterior cerebral artery were reduced after revascularization. Conclusions: Carotid revascularization improves anterior collateralization and reduces reliance on posterior collateral pathways via the CoW. Carotid stenting and endarterectomy appear to have different early effects on collateralization.
引用
收藏
页码:699 / 705
页数:7
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