World J Vasc Surg | Volume 8, Issue 1 | Research Article | Open Access
Sotman A Schwalb L, Mannheim D, Hayeq H and Galili O
Department of Vascular and Endo-Vascular Surgery, Carmel Medical Center, Israel
Department of Vascular and Endo-Vascular Surgery, Hadassah Medical Center, Israel
Department of Medicine, Hebrew University of Jerusalem, Jerusalem, Israel
*Correspondance to: Offer Galili
Fulltext PDFObjective: During Carotid Endarterectomy cerebral perfusion is maintained by the existence of collateral circulation through the Circle of Willis. Most patients tolerate Internal Carotid artery clamping and several intraoperative methods are used to evaluate cerebral perfusion and subsequently the need of extra-anatomical shunt. However, no current method allows reliable preoperative prediction of the need for shunt placement. In this study we try to determine pre-operative variables that may predict the need for shunt. Design: Single-center retrospective cohort study. Methods: A total of 102 patients with severe carotid artery stenosis who underwent carotid endarterectomy in Carmel Medical Center were enrolled. Demographical data, comorbidities and pre-operative anatomical parameters were registered. Predictive parameters assessed were (1) degree of stenosis, (2) degree of calcification, (3) completeness of the anterior circulation of circle of Willis, (4) existence of symptoms in the past 6 months. During surgery the indication for shunt placement was neurological changes (under local anesthesia) or stump pressure measurements (under general anesthesia). 30-days morbidity and mortality were documented. Results: Of 102 cases, 101 were included in the analysis. Extra-anatomical shunt was used in 12 procedures (11.9%). Demographics and co-morbidities, as well as symptoms and degrees of stenosis and calcification, did not differ between shunted and non-shunted patients. Incomplete circle of Willis was significantly higher in the shunted group (83.3% vs 11.2% respectively, P< 0.001). Lack of a complete circle of Willis was the only parameter that correlated significantly with stump pressure below 50mmHg (76.5% vs 8.3% in patient with stump pressure above 50mmHg, P<0.0001). There was no significant difference in 30-days morbidity and mortality between the two groups. Conclusions: Lack of a complete circle of Willis can serve as a predictor for the need of extraanatomical shunt during carotid endarterectomy. Further research with larger cohort is needed.
Carotid endarterectomy; Circle of Willis; Shunt; Perfusion
Sotman A, Schwalb L, Mannheim D, Hayeq H, Galili O. Circle of Willis – An Essential Part of Pre-
Operative Assessment Before Carotid Endarterectomy. World J Vasc Surg. 2026; 8(1): 1038..