Surgical and Radiologic Anatomy

, Volume 27, Issue 6, pp 544–547

The value of phase-contrast magnetic resonance angiography of the circle of Willis in predicting cerebral ischemia-hypoxia (shunt need) during carotid endarterectomy

Radiologic Anatomy

DOI: 10.1007/s00276-005-0032-5

Cite this article as:
Bagan, P., Azorin, J., Salama, J. et al. Surg Radiol Anat (2005) 27: 544. doi:10.1007/s00276-005-0032-5


Background: Cerebral perfusion during carotid cross-clamping depends on collateral function of the circle of Willis. The aim of this study was to determine the value of 3D Phase-Contrast (3D PC) MR angiography in predicting pre-operatively the need of shunting. Methods: 3D PC MR angiography were performed in 121 patients before carotid endarterectomy under locoregional anaesthesia. Based on the MR analysis, the risk of cerebral ischemia–hypoxia during clamping was classified as high, moderate and low. The analysis was then correlated with intraoperative neurological examination. Results: In patients with high risk of cerebral ischemia (n=9), immediate cerebral ischemia developed in all patients within one min of clamping (P<0.001). All nine underwent shunt placement. In six of the patients with moderate risk (n=46), cerebral ischemia occurred between 20 and 25 min after clamping; All occurred during intraoperative hypotension. Conclusion: 3D PC MR angiography can significantly determine the need of shunting in patients with important risk of immediate intraoperative cerebral ischemia. It also focuses on the intraoperative blood pressure stability in patients with moderate risk of ischemia.


Cerebral ischemiaMagnetic Resonance angiographyCarotid surgeryCarotid arteryCircle of WillisAnatomy

Copyright information

© Springer-Verlag 2005

Authors and Affiliations

  • P. Bagan
    • 1
    • 6
  • J. Azorin
    • 1
  • J. Salama
    • 2
    • 4
  • J-L. Dumas
    • 3
    • 4
    • 5
  1. 1.Department of Thoracic and Vascular surgery, Avicenne HospitalAP-HP, University Paris XIIIBobignyFrance
  2. 2.Department of Neurology, Avicenne HospitalAP-HP, University Paris XIIIBobignyFrance
  3. 3.Department of Radiology, Avicenne HospitalAP-HP, University Paris XIIIBobignyFrance
  4. 4.Department of Applied Anatomy of Paris-NordUFR SMBH, University of Paris XIIIBobignyFrance
  5. 5.Department of Applied Anatomy of EAUFR SMBH, University of Paris XIIIBobignyFrance
  6. 6.service de Chirurgie ThoraciqueHôpital Europèen Georges PompidouParisFrance