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The role of the circle of Willis in graded occlusion of the internal carotid artery in man

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Summary

Protracted studies on bilateral internal carotid artery (ICA) flow using implantable electromagnetic flow probes were performed in ten patients undergoing graded occlusion for infraclinoid saccular aneurysm. The ICA flow was generally lower on the side of the aneurysm in the eight patients with previous subarachnoid haemorrhage, and the difference was statistically significant at the 5% level. This was attributed to the increased vascular resistance in the affected hemisphere. A contralateral ICA flow increase, varying between 14 and 73%, was found in all patients at test occlusion of the ipselateral ICA.

Three patients showed electro-encephalographic evidence of intolerance to clamping of the artery. They also showed the lowest contralateral compensatory increase (14–17%) at test occlusion. Furthermore, a delay in contralateral flow response to stepwise trial occlusion was observed in these patients. Two of these patients suffered ischaemic attacks in spite of special precautions taken during the subsequent graded clamping procedure.

Complications also occurred in two patients who showed a satisfactory response to test oclusion. These complications, however, were found to be caused by thrombo-embolic processes in the ipselateral ICA during the period of graded occlusion and were not related to insufficient collaterals.

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Authors and Affiliations

  1. Department of Neurosurgery, University Hospital, Bikshospitalet, Oslo, Norway

    H. Nornes

  2. Institute for Surgical Research, University Hospital, Bikshospitalet, Oslo, Norway

    H. Nornes

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  1. H. Nornes
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Nornes, H. The role of the circle of Willis in graded occlusion of the internal carotid artery in man. Acta neurochir 28, 165–177 (1973). https://doi.org/10.1007/BF01432228

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  • DOI: https://doi.org/10.1007/BF01432228

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