Non-Invasive Tools in Perioperative Stroke Risk Assessment for Asymptomatic Carotid Artery Stenosis with a Focus on the Circle of Willis

This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Func...

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Bibliographic Details
Published in:Journal of clinical medicine 2024-05, Vol.13 (9), p.2487
Main Authors: Lengyel, Balázs, Magyar-Stang, Rita, Pál, Hanga, Debreczeni, Róbert, Sándor, Ágnes Dóra, Székely, Andrea, Gyürki, Dániel, Csippa, Benjamin, István, Lilla, Kovács, Illés, Sótonyi, Jr, Péter, Mihály, Zsuzsanna
Format: Article
Language:English
Subjects:
Algorithms
Asymptomatic
Carotid arteries
Carotid artery diseases
Cattle
Circle of Willis
Complications and side effects
Decision-making
Diagnosis
Embolization
Hemodynamics
Infrared spectroscopy
Ischemia
Medical imaging
Morphology
Patients
Physiological aspects
Risk assessment
Risk factors
Saccades (Eye movements)
Stenosis
Stroke
Stroke (Disease)
Surgery
Ultrasonic imaging
Veins & arteries
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Summary:This review aims to explore advancements in perioperative ischemic stroke risk estimation for asymptomatic patients with significant carotid artery stenosis, focusing on Circle of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed in the context of evaluating cerebrovascular reserve capacity and collateral vascular systems, particularly the CoW. These non-invasive diagnostic tools provide additional valuable insights into the cerebral perfusion status. They support biomedical modeling as the gold standard for the prediction of the potential impact of carotid artery stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment strategies, including selective shunting, are explored with a focus on CoW variations and their implications for perioperative ischemic stroke and cognitive function decline. By synthesizing these insights, this review underscores the potential of non-invasive diagnostic methods to support clinical decision making and improve asymptomatic patient outcomes by reducing the risk of perioperative ischemic neurological events and preventing further cognitive decline.
ISSN:2077-0383
2077-0383
DOI:10.3390/jcm13092487