Luca Saba MD, Presenter: Nothing to Disclose

Roberto Sanfilippo MD, Abstract Co-Author: Nothing to Disclose

Michele Anzidei MD, Abstract Co-Author: Nothing to Disclose

Mario Piga, Abstract Co-Author: Nothing to Disclose

Roberto Montisci MD, Abstract Co-Author: Nothing to Disclose

Local anaesthesia during carotid endarterectomy (CEA) has been proposed as the method of choice but sometimes the intolerance to the cross-clamping (CC) can occur. The purpose of this study was to evaluate whether preoperative MRA can predict cross-clamping (CC) intolerance.

Fifty-one patients (41 males; 10 females, mean age 72.4 years, age range 52-86 years) underwent 55 carotid endarterectomies (CEA) in local anaesthesia. Before CEA patients underwent Magnetic Resonance Angiography (MRA) of the Circle of Willis (CoW) and patients were classified in 3 groups: group A patients with a complete CoW; group B patients with one interruption in the CoW; group C patients with two or more interruptions in the CoW. Association between the number of anatomical variants in the CoW and the presence of CC intolerance has been evalued by 3x2 χ2-test.

The prevalence of intolerance of CC was 21.8% (12\55). The 3x2 χ2-test showed a statistically significant association between the intolerance to CC and two or more interruptions in the CoW (p value = 0.00001). No neurological complications were observed.

Results of our study showed that two or more interruptions of the CoW identified by MRA are associated with the intolerance to CC during CEA. For these patients CEA under local anaesthesia should be not recommended and surgery under general anaesthesia or Carotid artery stenting should be preferred.

CEA under local anaesthesia should be not recommended in those patients with 2 or more interruptions in the CoW identified by MRA.

Saba, L, Sanfilippo, R, Anzidei, M, Piga, M, Montisci, R, Potentiality of Magnetic Resonance Angiography to Predict Intolerance to Cross-clamping in Carotid Endarterectomy.  Radiological Society of North America 2012 Scientific Assembly and Annual Meeting, November 25 - November 30, 2012 ,Chicago IL. http://archive.rsna.org/2012/12026889.html