title: Carotid endarterectomy in patients with foetal-type posterior circle of Willis: is there an indication for local anaesthesia?
abstract: Foetal-type posterior circle of Willis is a common anatomical variation with a variable degree of vessel asymmetry. In patients with this abnormality, carotid endarterectomy (CEA) may create cerebral hypo-perfusion intraoperatively, and this may be underestimated under general anaesthesia. There is currently no evidence that anatomical variations in the circle of Willis represent an independent risk factor for stroke. Moreover, there is a paucity of data on treating patients with such anatomical variations and co-existing ICA stenosis. We present a case of CEA under local anaesthesia (LA) in a 52-year-old female patient with symptomatic stenosis of the right ICA and coexistent foetal-type posterior circle of Willis. There were no post-operative complications and she was discharged free from symptoms. She was seen again 3 months later and was free from complications. This case higlights that LA should be strongly considered to enable better intra-operative neurological monitoring in the event of foetal-type posterior circle of Willis.
authors.affiliation: Department of Vascular Surgery, Red Cross Hospital, Athens, Greece. dimmaras@gmail.com
authors.forename: D
authors.initials: D
authors.lastname: Maras
authors.forename: I
authors.initials: I
authors.lastname: Tzormpatzoglou
authors.forename: T T
authors.initials: TT
authors.lastname: Papas
authors.forename: N
authors.initials: N
authors.lastname: Papanas
authors.forename: I
authors.initials: I
authors.lastname: Kotsikoris
authors.forename: S
authors.initials: S
authors.lastname: Kotsiou
authors.forename: E
authors.initials: E
authors.lastname: Maltezos
mesh_terms: D000772:Anesthesia, Local; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000601:surgery*; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D020785:Central Nervous System Vascular Malformations / Q000150:complications* / Q000000981:diagnostic imaging; D002533:Cerebral Angiography; D002941:Circle of Willis / Q000002:abnormalities* / Q000000981:diagnostic imaging; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008875:Middle Aged; D016896:Treatment Outcome