Influence of Circle of Willis Anatomy on the Safety of Carotid Endarterectomy under Regional Block

Abstract

Abstract The success of carotid endarterectomy, an effective surgery in managing carotid stenosis, relies on reducing procedure complications. Therefore, prior understanding of the anatomy of the Circle of Willis is crucial to prevent complications. Objective: To evaluate the anatomy of the Circle of Willis to determine the safety of endarterectomy in patients with carotid stenosis. Methodology: A retrospective study in patients aged 18 or older with carotid stenosis indicating endarterectomy. Descriptive analysis, chi-square test, and Fisher's exact test were performed, adopting a significance level of p < 0.05. Results: A total of 69 patients were evaluated, with an average age of 68.48 years; males represented 59.4% (n=41) of the sample, and 4.3% (n=3) did not tolerate the carotid artery cross-clamping test. Patients with patency of the anterior communicating artery and posterior communicating arteries were 18.2 times more likely to tolerate the cross-clamping test (p=0.026; 95% CI: 2.789-370.720). Conclusion: The results of this study demonstrate that carotid endarterectomy is safe. In the evaluation of the Circle of Willis anatomy, it was evident that patients with an absent anterior communicating artery and absent posterior communicating arteries had a higher risk of carotid artery cross-clamping test intolerance, and the absence of the anterior communicating artery was associated with occurrences of complications in CEA. These findings emphasize the importance of assessing Circle of Willis anatomy preoperatively to determine the safety of the procedure.