Carotid Endarterectomy Improves Cerebrovascular Reserve Capacity Preferentially in Patients with Preoperative Impairment as Indicated by Asymmetric BOLD Response to Hypercapnia
In patients with symptomatic carotid artery disease the predominant mechanism causing ischaemic injury is considered to be thromboembolic, however compromise of cerebral haemodynamics is considered to be a significant factor. Removal of the embolic source is accepted as the major benefit from Carotid Endarterectomy (CEA), however improvement in cerebral haemodynamics may be another beneficial outcome as suggested by Transcranial doppler (TCD). Blood Oxygen Level-Dependent (BOLD) hypercapnia functional Magnetic Resonance imaging (fMRI) can be used to map the Cerebrovascular Reserve (CVR). The aim of this study was to assess the effects of carotid surgery on cerebral haemodynamics in patients with carotid artery disease using a hypercapnia BOLD fMRI and assessment of hemispheric asymmetry.