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

Cover Page


Cite item

Full Text

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

Anastasia N. Sergeeva

Research Center of Neurology

Author for correspondence.
Email: sergeevan83@gmail.com
ORCID iD: 0000-0002-2481-4565

Cand. Sci. (Med.), researcher, Radiology department

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Rodion N. Konovalov

Research Center of Neurology

Email: sergeevan83@gmail.com
ORCID iD: 0000-0001-5539-245X

Cand. Sci. (Med.), senior researcher, Neuroradiology department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Dmitry V. Sergeev

Research Center of Neurology

Email: sergeevan83@gmail.com
ORCID iD: 0000-0002-9130-1292

Cand. Sci. (Med.), neurologist, Neurorehabilitation department with TMS group

Russian Federation, 125367, Russia, Moscow, Volokolamskoye shosse, 80

Aleksander S. Suslin

Research Center of Neurology

Email: sergeevan83@gmail.com
Russian Federation, Moscow

Sergey I. Skrylev

Research Center of Neurology

Email: sergeevan83@gmail.com
Russian Federation, Moscow

Marina V. Krotenkova

Research Center of Neurology

Email: sergeevan83@gmail.com
ORCID iD: 0000-0003-3820-4554

D. Sci. (Med.), Head, Neuroradiology department

Russian Federation, 125367 Moscow, Volokolamskoye shosse, 80

Mikhail A. Piradov

Research Center of Neurology

Email: sergeevan83@gmail.com
ORCID iD: 0000-0002-6338-0392

D. Sci. (Med.), Professor, Full Member of the Russian Academy of Sciences, Director

Russian Federation, Moscow

References

  1. Верещагин Н.В., Мусатова И.В., Пирадов М.А.Радиоизотопный (133Хе) ингаляционный метод определения регионарного мозгового кровотока. Журн. неврол. и психиатрии им. C.C. Корсакова. 1983; 1: 16–21.
  2. Давыденко И.С., Кротенкова М.В., Коновалов Р.Н., Пирадов М.А. Проспективное сравнение компьютерно-томографической, магнитно-резонансной ангиографии и дигитальной субтракционной ангиографии для определения степени гемодинамически значимых стенозов внутренних сонных артерий. Анн. клинич. и эксперим. неврол. 2008; 3: 19–24.
  3. Кротенкова М.В. Диагностика острого инсульта: нейровизуализационные алгоритмы: дис. …док. мед. наук. М., 2011: 314.
  4. Пирадов М.А. Мозговой кровоток у больных с закупоркой внутренних сонных артерий: дис. …канд. мед. наук. М., 1984: 131.
  5. Пирадов М.А., Верещагин Н.В., Лунев Д.К. Гемодинамические факторы риска повторных инфарктов мозга у больных с закупоркой ВСА. Журнал неврологии и психиатрии им. C.C. Корсакова 1986; 1: 11–14.
  6. Сергеев Д.В. Острый ишемический инсульт: клинико-КТ-перфузионное исследование: дис. …канд. мед. наук. М., 2010: 91.
  7. Сергеев Д.В., Лаврентьева А.Н., Кротенкова М.В. Методика перфузионной компьютерной томографии в диагностике острого ишемического инсульта. Анн. клинич. и эксперим. неврол. 2008; 3: 30–37.
  8. Суслина З.А., Пирадов М.А. Инсульт: диагностика, лечение, профилактика. Под ред. З.А. Суслиной, М.А. Пирадова. М.: МЕДпресс-информ, 2008.
  9. Танашян М.М., Лагода О.В., Домашенко М.А. Профилактика ишемических инсультов у пациентов с атеросклеротической патологией магистральных артерий головы. Атмосфера. Нервные болезни 2008; 1: 2–6.
  10. Alberts M.J. Results of a multicentre prospective randomizedtrial of carotid artery stenting vs carotid endarterectomy. Stroke 2001; 32: 325.
  11. Asymptomatic Carotid Surgery Trial Collaborative Group. Preventionof disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: ransomised controlled trial. Lancet 2004; 363: 1491–1502.
  12. Axel L. Cerebral blood flow determination by rapidsequence computed tomography. Radiology 1980; 137: 679–686.
  13. Brott T.G., Hobson R.W., Howard G. et al. CREST Investigators. Stenting versus endarterectomy for treatment of carotid-artery stenosis. N Engl J Med. 2010 Jul 1; 363 (1): 11–23.
  14. CAVATAS Investigators. Endovascular versus surgical treatmentin patients with carotid stenosis in the Carotid and Vertebral Artery Transluminal Angioplasty Study (CAVATAS): a randomized trial. Lancet 2001; 357: 1729–1737.
  15. ChuangY.-M., Chang Y.-J. et al. Correlation between the flow pattern of the circle of Willis and segmental perfusion asymmetry after carotid artery revascularization. EJN 2011; 18: 1132–1138.
  16. Derdeyn C.P., Grubb R.L. Jr., Powers W.J. Cerebral hemodynamic impairment: methods of measurement and association with stroke risk. Neurology 1999; 53: 251–259.
  17. Duan Y,Li G,Yang Y, et al. Change sincerebral hemodynamics after carotid stenting of symptomatic carotid artery. Eur J Radiol. 2012; 81 (4): 744–748.
  18. European Carotid Surgery Trial Collaborators. Randomized trial of endarterectomy for recently symptomatic carotid stenosis: Final results of the MRC European Carotid Surgery Trial (ECST). Lancet 1998; 351: 1379–1387.
  19. Hobson R.W., Weiss D.G., Fields W.S. et al. Efficacy of carotid endarterectomy for asymptomatic carotid stenosis.TheVeterans Affairs Cooperative Study Group. N Engl JMed 1993; 328: 221–227.
  20. Jongen L.M., van der Worp H.B., Waaijer A. et al. Interrelation between the degree of carotid stenosis, collateral circulation and cerebral perfusion. Cerebrovasc Dis. 2010; 30: 277–284.
  21. Kluytmans M, van der Grond J, Eikelboom BC, Viergever MA. Longterm hemodynamic effects of carotid endarterectomy. Stroke. 1998;29:1567–1572.
  22. Soinne L., Helenius J., Tatlisumak T. et al. Cerebral Hemodynamics in Asymptomatic and SymptomaticPatients With High-Grade Carotid Stenosis Undergoing Carotid Endarterectomy. Stroke 2003; 34: 1655-1661.
  23. Lishmanov Yu., Shvera I. et al. The affect of carotid endarterectomy on cerebral blood flow and cerebral blood volume studied by SPECT. J. Neuroradiol.1997; 24: 155–162.
  24. Caplan L., Henerici M. Impared clearance of emboli (washut) is an important link between hypoperfusion, embolism and ischemic stroke. Arch Neurol. 1998; 55: 1475–1482.
  25. Mathias K. A new catheter system for percutaneous transluminalangioplasty of carotid artery stenosis. Fortschr Med 1997; 95: 1007–1011.
  26. Merckel L.G., Van der Heijden J., Jongen L.M. et al. Effect of stenting on cerebral CT perfusion in symptomatic and asymptomatic patients with carotid artery stenosis. AJNR Am J Neuroradiol. 2012; 33 (2): 280–285.
  27. Norris J.W. Risks of cerebral infarction, myocardial infarction and vascular death in patients with asymptomatic carotid disease, transient ischemic attacks and stroke. Cerebrovasc Dis. 1992; 2 (suppl. 1): 2–5.
  28. North American Symptomatic Carotid Endarterectomy Trial Collaborators. Beneficial effect of carotid endarterectomy in symptomaticpatients with high-grade stenosis. N Engl J Med. 1991; 325: 445–453.
  29. Rothwell P.M. Carotid artery disease and the risk of ischaemic stroke and coronary vascular events.Cerebrovasc Dis 2000; 10 (suppl. 5):21–33.
  30. Szarmach A., Halena G., Buczny J. et al. Evaluation of changes in the parameters of brain tissue perfusion in multi-slice computed tomography in patients after carotid artery stenting. Pol J Radiol. 2011; 76 (3):7–15.
  31. The SPACE Collaborative Group. 30-day results from the SPACE trial of stent-protected angioplasty versus carotid endarterectomy in symptomatic patients. Lancet 2006; 368: 1239–1247.
  32. Trojanowska A., Drop A., Jargiello T. et al. Changes in cerebral hemodynamics after carotid stenting: evaluation with CT perfusion studies. J Neuroradiol 2006; 33: 169–174.
  33. Vanninen R., Koivisto K., Tulla H. et al. Hemodynamic effects of carotid endarterectomy by magnetic resonance flowquantification. Stroke. 1995; 26: 84–89.
  34. Vernieri F., Pasqualetti P., Passarelli F. et al.Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity. Stroke 1999; 30: 593–598.
  35. Waaijer A., van Leeuwen M.S., van Osch M.J. et al. Changes in cerebral perfusion after revascularization of symptomatic carotid artery stenosis: CT measure- ment. Radiology 2007; 245: 541–548.
  36. Warlow С., van Gijn J., Dennis M. et al. Stroke: practical management. 3rd ed. Blackwell Publishing, 2008: 1008.

Supplementary files

Supplementary Files
Action
1. JATS XML
Download

Copyright (c) 2014 Sergeeva A.N., Konovalov R.N., Sergeev D.V., Suslin A.S., Skryilev S.I., Krotenkova M.V., Piradov M.A.

Creative Commons License
This work is licensed under a Creative Commons Attribution 4.0 International License.
СМИ зарегистрировано Федеральной службой по надзору в сфере связи, информационных технологий и массовых коммуникаций (Роскомнадзор).
Регистрационный номер и дата принятия решения о регистрации СМИ: серия ПИ № ФС 77-83204 от 12.05.2022.


This website uses cookies

You consent to our cookies if you continue to use our website.

About Cookies