{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,6]],"date-time":"2026-06-06T09:00:58Z","timestamp":1780736458124,"version":"3.54.1"},"reference-count":34,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"4","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["FOC"],"published-print":{"date-parts":[[2017,4]]},"abstract":"\n OBJECTIVE<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n METHODS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>\n \n RESULTS<\/jats:title>\n 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 < 0.041). These findings remained statistically significant in a logistic regression analysis for possible confounders (p < 0.024). A receiver operating curve analysis of preoperative data indicated that a MAP > 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 < 0.0092).<\/jats:p>\n <\/jats:sec>\n \n CONCLUSIONS<\/jats:title>\n 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.<\/jats:p>\n <\/jats:sec>","DOI":"10.3171\/2017.1.focus16487","type":"journal-article","created":{"date-parts":[[2017,4,1]],"date-time":"2017-04-01T03:44:48Z","timestamp":1491018288000},"page":"E18","source":"Crossref","is-referenced-by-count":2,"title":["The circle of Willis predicts the antihypertensive effects of carotid artery stenting"],"prefix":"10.3171","volume":"42","author":[{"given":"David R.","family":"Santiago-Dieppa","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Brian R.","family":"Hirshman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arvin","family":"Wali","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J.","family":"Scott Pannell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yasaman","family":"Alam","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Scott","family":"Olson","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Vincent J.","family":"Cheung","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jeffrey A.","family":"Steinberg","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mihir","family":"Gupta","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alexander A.","family":"Khalessi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1754","reference":[{"key":"b1-focus16487","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"3491","DOI":"10.1161\/STROKEAHA.111.624478","article-title":"Effects of carotid endarterectomy or stenting on blood pressure in the International Carotid Stenting Study (ICSS)","volume":"42","author":"Altinbas A,","year":"2011","unstructured":"Altinbas A, Algra A, Brown MM, Featherstone RL, Kappelle LJ, de Borst GJ, : Effects of carotid endarterectomy or stenting on blood pressure in the International Carotid Stenting Study (ICSS). 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