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Abstract

Purpose

To evaluate intracranial hemodynamic stabilization patterns after carotid artery stenting (CAS) in patients having variable collateral developments before CAS.

Methods

The hemodynamic and angiographic data of 62 patients (58 men; mean age 68.0±8.4 years) who underwent CAS for unilateral proximal internal carotid artery stenosis were analyzed. The patients had transcranial Doppler examinations before and at 1 and 90 days after CAS. Patients were classified according to pre-CAS mean blood flow velocity (MBFV) of the ipsilateral middle cerebral artery (MCA): low (<30 cm/s; n=17), normal (30 to 48 cm/s; n=26), or high (>48 cm/s; n=19). The collaterals from contralateral anterior and/or posterior circulations prior to CAS, the stabilization pattern of MBFV, and the pulsatility index (PI) after CAS were compared across the 3 groups.

Results

The presence of collaterals was lowest in the low MBFV group (17.6% of patients) than in the normal (38.5%) or high (68.4%) MBFV groups (p=0.008). The low MBFV group exhibited an increase in MBFV and PI in the ipsilateral MCA at 1 and 90 days after CAS (p<0.05). By contrast, the high MBFV group exhibited a decrease in MBFV and no change in PI in the ipsilateral MCA up to 90 days after CAS (p<0.05). The normal MBFV group showed an increase in MBFV at post-CAS day 1 but a subsequent decrease at 90 days and an increase in PI in the ipsilateral MCA at 1 and 90 days post-CAS (p<0.05).

Conclusion

The pattern of post-CAS intracranial hemodynamic stabilization differs according to the pre-CAS MBFV in the ipsilateral MCA.

Keywords

carotid stenosis internal carotid artery carotid artery stenting middle cerebral artery blood flow velocity pulsatility index intracranial hemodynamic stabilization transcranial Doppler

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References

Arakawa

Minematsu

Hirano

. Topographic distribution of misery perfusion in relation to internal and superficial borderzones. AJNR Am J Neuroradiol. 2003;24:427–435.

Jorgensen

Torvik

. Ischaemic cerebrovascular diseases in an autopsy series. 2. Prevalence, location, pathogenesis, and clinical course of cerebral infarcts. J Neurol Sci. 1969;9:285–320.

Meyer

Denny-Brown

. The cerebral collateral circulation. I. Factors influencing collateral blood flow. Neurology. 1957;7:447–458.

Kaneko

Kuwabara

Mihara

. Validation of the CBF, CBV, and MTT values by perfusion MRI in chronic occlusive cerebrovascular disease: a comparison with 15O-PET. Acad Radiol. 2004;11:489–497.

Busch

Buschmann

Mies

. Arteriogenesis in hypoperfused rat brain. J Cereb Blood Flow Metab. 2003;23:621–628.

Coyle

Panzenbeck

. Collateral development after carotid artery occlusion in Fischer 344 rats. Stroke. 1990;21:316–321.

Rutgers

Klijn

Kappelle

. A longitudinal study of collateral flow patterns in the circle of Willis and the ophthalmic artery in patients with a symptomatic internal carotid artery occlusion. Stroke. 2000;31:1913–1920.

Yadav

Wholey

Kuntz

. Protected carotid-artery stenting versus endarterectomy in high-risk patients. N Engl J Med. 2004;251:1493–1501.

Gurm

Yadav

Rayad

. Long-term results of carotid stenting versus endarterectomy in high-risk patients. N Engl J Med. 2008;358:1572–1579.

10.

Sanchez-Arjona

Sanz-Fernandez

Franco-Macias

. Cerebral hemodynamic changes after carotid angioplasty and stenting. AJNR Am J Neuroradiol. 2007;28:640–644.

11.

Sfyroeras

Karkos

Liasidis

. The impact of carotid stenting on the hemodynamic parameters and cerebrovascular reactivity of the ipsilateral middle cerebral artery. J Vasc Surg. 2006;44:1016–1022.

12.

Samuels

Joseph

Lynn

. A standardized method for measuring intracranial arterial stenosis. AJNR Am J Neuroradiol. 2000;21:643–646.

13.

Staikov

Arnold

Mattle

. Comparison of the ECST, CC, and NASCET grading methods and ultrasound for assessing carotid stenosis. European Carotid Surgery Trial. North American Symptomatic Carotid Endarterectomy Trial. J Neurol. 2000;247:681–686.

14.

Henderson

Eliasziw

Fox

. Angiographically defined collateral circulation and risk of stroke in patients with severe carotid artery stenosis. North American Symptomatic Carotid Endarterectomy Trial (NASCET) Group. Stroke. 2000;31:128–132.

15.

Sfyroerasv

Karkos

Liasidis

. The impact of carotid stenting on the hemodynamic parameters and cerebrovascular reactivity of the ipsilateral middle cerebral artery. J Vasc Surg. 2006;44:1016–1022.

16.

Ringelstein

Kahlscheuer

Niggemeyer

. Transcranial Doppler sonography: anatomical landmarks and normal velocity values. Ultrasound Med Biol. 1990;16:745–761.

17.

Hendrikse

Hartkamp

Hillen

. Collateral ability of the circle of Willis in patients with unilateral internal carotid artery occlusion: border zone infarcts and clinical symptoms. Stroke. 2001;32:2768–2773.

18.

Reinhard

Roth

Muller

. Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation. Stroke. 2004;35:1381–1387.

19.

Hsu

Chang

Kuo

. Cerebral hemodynamics and baroreflex sensitivity after carotid artery stenting. Acta Neurol Scand. 2013;127:46–52.

20.

Fan

Zhu

Chen

. The impact of carotid angioplasty and stenting on the cerebrovascular reactivity. Cerebrovasc Dis. 2012;34:13–17.

21.

Soinne

Helenius

Tatlisumak

. Cerebral hemodynamics in asymptomatic and symptomatic patients with high-grade carotid stenosis undergoing carotid endarterectomy. Stroke. 2003;34:1655–1661.

22.

Nielsen

Sillesen

Jorgensen

. The haemodynamic effect of carotid endarterectomy. Eur J Vasc Endovasc Surg. 2002;24:53–58.

23.

Riggs

Rupp

. Variation in form of circle of Willis. The relation of the variations to collateral circulation: anatomic analysis. Arch Neurol. 1963;8:8–14.

24.

Eftekhar

Dadmehr

Ansari

. Are the distributions of variations of circle of Willis different in different populations? - Results of an anatomical study and review of literature. BMC Neurol. 2006;6:22.

25.

De Silva

Silva

Amaratunga

. Types of the cerebral arterial circle (circle of Willis) in a Sri Lankan population. BMC Neurol. 2011;11:5.

26.

Hoksbergen

Legemate

Ubbink

. Collateral variations in circle of willis in atherosclerotic population assessed by means of transcranial color-coded duplex ultrasonography. Stroke. 2000;31:1656–1660.

27.

Manninen

Makinen

Vanninen

. How often does an incomplete circle of Willis predispose to cerebral ischemia during closure of carotid artery? Postmortem and clinical imaging studies. Acta Neurochir (Wien). 2009;151:1099–1105.

28.

de Riva

Budohoski

Smielewski

. Transcranial Doppler pulsatility index: what it is and what it isn't. Neurocrit Care. 2012;17:58–66.

29.

Czosnyka

Richards

Whitehouse

. Relationship between transcranial Doppler-determined pulsatility index and cerebrovascular resistance: an experimental study. J Neurosurg. 1996;84:79–84.

30.

Zweifel

Czosnyka

Carrera

. Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients. Neurosurgery. 2012;71:853–861.

31.

Markus

Clifton

Buckenham

. Improvement in cerebral hemodynamics after carotid angioplasty. Stroke. 1996;27:612–616.

Intracranial Hemodynamic Stabilization Patterns After Stenting of Severe Stenosis in the Proximal Internal Carotid Artery