Document Detail

Effect of carotid endarterectomy on primary collateral blood flow in patients with severe carotid artery lesions.
MedLine Citation:
PMID:  12775888     Owner:  NLM     Status:  MEDLINE    
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 (P=0.03). 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%, P<0.01) and a significant increase in diameter of both A1 segments (P<0.05) 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.
Jeroen Hendrikse; Dirk R Rutgers; Catharina J M Klijn; Bert C Eikelboom; Jeroen van der Grond
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Publication Detail:
Type:  Clinical Trial; Controlled Clinical Trial; Journal Article     Date:  2003-05-29
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  34     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2003 Jul 
Date Detail:
Created Date:  2003-07-04     Completed Date:  2003-08-01     Revised Date:  2004-11-17    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1650-4     Citation Subset:  IM    
Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands.
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MeSH Terms
Angiography, Digital Subtraction
Blood Flow Velocity / physiology
Carotid Artery, Internal / radiography,  surgery,  ultrasonography
Carotid Stenosis / diagnosis,  pathology,  surgery*
Cerebral Arteries / physiology
Cerebrovascular Circulation / physiology*
Circle of Willis / physiology*
Collateral Circulation / physiology*
Endarterectomy, Carotid*
Magnetic Resonance Angiography
Middle Aged
Treatment Outcome
Vascular Patency / physiology*

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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