This review aims to explore advancements in perioperative ischemic stroke risk estimation
for asymptomatic patients with significant carotid artery stenosis, focusing on Circle
of Willis (CoW) morphology based on the CTA or MR diagnostic imaging in the current
preoperative diagnostic algorithm. Functional transcranial Doppler (fTCD), near-infrared
spectroscopy (NIRS), and optical coherence tomography angiography (OCTA) are discussed
in the context of evaluating cerebrovascular reserve capacity and collateral vascular
systems, particularly the CoW. These non-invasive diagnostic tools provide additional
valuable insights into the cerebral perfusion status. They support biomedical modeling
as the gold standard for the prediction of the potential impact of carotid artery
stenosis on the hemodynamic changes of cerebral perfusion. Intraoperative risk assessment
strategies, including selective shunting, are explored with a focus on CoW variations
and their implications for perioperative ischemic stroke and cognitive function decline.
By synthesizing these insights, this review underscores the potential of non-invasive
diagnostic methods to support clinical decision making and improve asymptomatic patient
outcomes by reducing the risk of perioperative ischemic neurological events and preventing
further cognitive decline.
