Improvement in cerebral hemodynamics after carotid angioplasty.
ABSTRACT Carotid percutaneous transluminal angioplasty ( PTA) may offer an alternative treatment to carotid endarterectomy. However, in contrast to carotid endarterectomy, which has been shown to normalize impaired cerebral hemodynamics, the effects of carotid PTA are unknown. Therefore, we prospectively studied the effect of carotid PTA on both perioperative and postoperative cerebral hemodynamics.
Eleven patients undergoing carotid PTA for symptomatic carotid artery stenosis were prospectively studied. Transcranial Doppler recordings from the ipsilateral middle cerebral artery (MCA) were performed during the procedure. In addition, MCA blood flow velocity and CO2 reactivity were determined before PTA and at 2 days, 1 month, and 6 months after procedure. The results were compared with those in 11 similar patients undergoing carotid endarterectomy in whom measurements were performed before and 1 month after the operation.
During carotid PTA, in 2 of 11 patients during passage of the balloon catheter through the stenosis, MCA blood flow velocity fell transiently. In 6 of 11 patients there was a reduction in flow velocity (>50%) during balloon deflation, but this lasted only a few seconds. After the procedure there was a significant improvement in ipsilateral hypercapnic reactivity: preoperative value, 59.8+/-42.2% (mean+/-SD); 2 days, 77.9+/-31.4%; 1 month, 88.7+/-45.0%; 6 months, 89.8+/-33.9%; and (ANOVA P=.003) preoperative value versus 1 month, P<.02; versus 6 months, P<.02. In all cases in which reactivity was significantly impaired preoperatively, it returned to the normal range. Pulsatility index also increased significantly: preoperative value, 0.827+/-0.251 (mean+/-SD); 2 days, 0.992+/-0.262 (P=.002). Contralateral MCA hypercapnic reactivity also improved after carotid PTA. There was a similar improvement in ipsilateral hypercapnic reactivity after carotid endarterectomy.
Carotid PTA results in a normalization of impaired hemodynamics, as assessed by CO2 reactivity. The degree of improvement is similar to that seen after carotid endarterectomy.
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ABSTRACT: Carotid angioplasty stent placement (CAS) is an accepted alternative to endarterectomy. However, little is known about its effect on cerebral hemodynamics. We prospectively studied the early and delayed hemodynamic changes after CAS. Sixty patients underwent CAS for >or=70% internal carotid artery stenosis. Transcranial Doppler (TCD) was done before, 6 hours, and 30 days after CAS. Cerebrovascular reserve to apnea (CVR) was measured. On the ipsilateral side, basal middle cerebral artery (MCA) middle flow velocity (MFV) and pulsatility index (PI) increased from 49.7 cm/s and 0.85, respectively, to 62.5 cm/s and 1.09 immediately after CAS (P < .05); anterior cerebral artery (ACA) MFV and PI increased from 50.7 cm/s and 0.90, to 58.9 cm/s and 1.08 (P < .05); and posterior cerebral artery (PCA) MFV decreased from 47.5 to 36.5 cm/s, with no change in PI (P < .05). On the contralateral side, nonsignificant changes were seen on MCA, immediately after CAS; ACA and PCA MFV decreased from 63.7 and 45.3 cm/s to 50.3 and 38.6 cm/s, respectively (P < .05); ACA and PCA PI increased from 0.96 and 1.00, respectively, to 1.04 and 1.04 (P < .05). At 30 days, ipsilateral MCA MFV and PI were 52.8 cm/s and 1.12, respectively (P < .05), and contralateral values were 49.6 cm/s (P < .05) and 1.02 (nonsignificant), respectively. Basal ipsilateral and contralateral CVR improved from 26.0% to 37.0% (P < .05), and from 30.1% to 33.5% (nonsignificant), respectively, at 30 days. CAS produces an early significant increase of MFV and PI in the ipsilateral anterior circulation. This effect is maintained, though minor, 30 days later. In addition, CAS results in an improvement of CVR at 30 days.American Journal of Neuroradiology 04/2007; 28(4):640-4. · 3.17 Impact Factor
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ABSTRACT: The aim of this study was to assess the effects of percutaneous transluminal angioplasty with stenting on cerebral vasoreactivity in carotid stenosis (CS). We studied the changes in the middle cerebral artery using transcranial Doppler and the breath-holding index (BHI) after hypercapnia in 33 patients with CS (15 symptomatic, 18 asymptomatic) before and 1 day and 1 month after stenting. One day after stenting, the BHI significantly increased (p < 0.01) on the previously stenotic side in all patients. One month after stenting, the BHI was significantly higher on the contralateral side of asymptomatic (p < 0.05) and symptomatic patients (p < 0.01). Percutaneous transluminal angioplasty with stenting results in increasing improvement close to normalization of impaired cerebral vasoreactivity in patients with symptomatic and asymptomatic high-grade CS.Cerebrovascular Diseases 01/2008; 25(6):555-60. · 2.81 Impact Factor
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ABSTRACT: Stroke is one of the leading causes of morbidity and mortality in the United States. Approximately 700,000 Americans suffer from a stroke per year and 270,000 of these patients will die as a result of their stroke. The etiology of cerebrovascular events can be attributed to carotid artery disease in 20-30% of cases. Carotid endarterectomy has been shown to be beneficial in selected patients with symptomatic and asymptomatic carotid artery stenosis. Percutaneous treatment of carotid disease appears to be effective when performed with distal protection by an experienced operator. This review presents the clinical trial data regarding surgical and percutaneous management of carotid disease.Current problems in cardiology 07/2008; 33(6):291-316. · 3.96 Impact Factor