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首页> 外文期刊>Neurosurgical focus >The circle of Willis predicts the antihypertensive effects of carotid artery stenting
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The circle of Willis predicts the antihypertensive effects of carotid artery stenting

机译：威利斯的圈子预示着颈动脉支架置入术的降压作用

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OBJECTIVE Carotid artery stenting (CAS) has antihypertensive effects, but the durability and degree of this response remain variable. The authors propose that this clinical variability is a function of the presence or absence of a complete circle of Willis (COW). Incomplete COWs perfuse through a higher-resistance pial collateral pathway, and therefore patients may require a higher mean arterial pressure (MAP). Carotid artery revascularization in these patients would reduce the end-organ collateral demand that has been hypothesized to drive the MAP response. METHODS Using a retrospective, nonrandomized within-subject case-control design, the authors compared the postoperative effects of CAS in patients with and without a complete COW by using changes in MAP and antihypertensive medication as end points. They recorded MAP and antihypertensive medications 3 months prior to surgery, preoperatively, immediately postoperatively, and at the 3-month follow-up. RESULTS Data were collected from 64 consecutive patients undergoing CAS. Patients without a complete COW (25%) were more likely to demonstrate a decrease in BP response to stenting (i.e., a drop in MAP of 10 mm Hg and/or a reduction or cessation of BP medications at 3 months postoperatively). Of the patients in the incomplete COW cohort, 75% had this outcome, whereas of those in the complete COW cohort, only 41% had it (p 96.3 mm Hg was 55.5% sensitive and 57.4% specific for predicting a complete COW and that patients with a MAP > 96.3 mm Hg were more likely to demonstrate a good MAP decrease following CAS (p CONCLUSIONS CAS is associated with a significant decrease in MAP and/or a reduction/cessation in BP medications in patients in whom a complete COW is absent.
机译：目的颈动脉支架置入术（CAS）具有降压作用，但是这种反应的持久性和程度仍然不定。作者提出，这种临床变异性取决于是否存在完整的Willis圆（COW）。 COWs的不完全通过阻力较高的皮层侧支通路灌注，因此患者可能需要更高的平均动脉压（MAP）。这些患者的颈动脉血运重建将减少已被假设为驱动MAP反应的终末器官附带需求。方法采用回顾性，非随机的受试者内部病例对照设计，作者通过以MAP和降压药物的变化为终点，比较了有无COW的患者CAS的术后效果。他们在手术前3个月，术前，术后立即以及3个月的随访中记录MAP和降压药。结果收集了连续64例行CAS的患者的数据。没有完全COW（25％）的患者更有可能表现出对支架置入的BP反应降低（即术后3个月MAP下降10 mm Hg和/或BP药物减少或停止）。在未完成COW队列中的患者中，有75％达到了这一结果，而在完全COW队列中，只有41％达到了这一结果（p 96.3 mm Hg的敏感性为55.5％，对预测完全COW的特异性为57.4％ MAP> 96.3 mm Hg的患者更有可能在CAS后出现良好的MAP降低（p结论对于没有完整COW的患者，CAS与MAP显着降低和/或BP药物减少/停止有关。

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