Cerebral perfusion changes in patients with carotid artery stenosis after surgical revascularization

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Abstract

Assessment of cerebral perfusion and collateral circulation in patients with carotid stenosis might have prognostic value for effective blood flow restoration after carotid revascularization. To evaluate the changes of cerebral perfusion we studied 41 patients with moderate and severe carotid stenosis before and after surgical or endovascular treatment. Perfusion CT at the level of basal ganglia was performed in 17 patients with moderate (50–69%) and 24 patients with severe (70–99%) carotid stenosis for 3 times: before intervention (transluminal angioplasty with stenting or carotid endarterectomy), 3 to 7 days and 1 to 3 months after treatment. Additionally, single CT perfusion study was done in 39 patients without carotid stenosis (control group). We found that surgical recanalization of internal carotid artery may aid restoring cerebral blood flow characteristics in the MCA area to the levels similar to those in control group (namely, decrease of MTT and CBV and increase of CBF). However, in anterior and posterior watershed zones, which are known to be the most vulnerable by chronic hypoperfusion, blood flow normalization was seen only in patients with complete circle of Willis and with moderate carotid stenosis.Thus, prognostic factors for inadequate blood flow restoration in patients with carotid artery stenosis after revascularization include severe stenosis (>70%) and incomplete circle of Willis.

About the authors

A. N. Sergeeva

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Author for correspondence.
Email: platonova@neurology.ru
Russian Federation

R. N. Konovalov

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

D. V. Sergeev

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

A. S. Suslin

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

S. I. Skryilev

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

M. V. Krotenkova

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

M. A. Piradov

Research Center of Neurology, Russian Academy of Medical Sciences (Moscow)

Email: platonova@neurology.ru
Russian Federation

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Copyright (c) 2017 Sergeeva A.N., Konovalov R.N., Sergeev D.V., Suslin A.S., Skryilev S.I., Krotenkova M.V., Piradov M.A.

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