Cerebral blood flow reserve assessment in symptomatic versus asymptomatic high-grade internal carotid artery stenosis.

Nighoghossian, Norbert; Trouillas, P; Philippon, B.; Itti, R.; Adeleine, P.

doi:10.1161/01.str.25.5.1010

Cited by 31 publications

(22 citation statements)

References 27 publications

(12 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although several studies showed impaired reserve capacity that improved after CEA in these patients, 12,18 other studies failed to show decreased reserve capacity 19 or showed impaired reactivity and subsequent improvement after CEA only in a small subgroup of patients. 17 Because we found no indication of vasodilatory compensation (no increased rCBV), we speculate that the beneficial effect of CEA in patients with a unilateral severe stenosis of the ICA is caused by removal of the embolic source rather than by restoration of the cerebral blood flow.…”

Section: Discussionmentioning

confidence: 95%

See 1 more Smart Citation

Long-Term Hemodynamic Effects of Carotid Endarterectomy

Kluytmans¹,

Eikelboom²,

Viergever³

1998

Stroke

View full text Add to dashboard Cite

Background and Purpose-The presence and importance of hemodynamic factors to the beneficial effect of carotid endarterectomy (CEA) in patients with severe stenosis of the internal carotid artery (ICA) is unclear. The purpose of this study was to investigate possible hemodynamic changes caused by a severe ICA stenosis and the subsequent changes after CEA. Methods-Hemodynamic parameters were acquired with dynamic susceptibility contrast MRI. Regional cerebral blood volume (rCBV), mean transit time (MTT), time of appearance, and time to peak were determined in 19 patients with severe stenosis (Ͼ70%) of the ICA before and after CEA and in 33 control subjects. Four patients had an occlusion of the contralateral ICA. Corresponding T2-weighted MRI and inversion recovery MRI scans were used for segmentation of gray and white matter regions. Results-In the hemisphere ipsilateral to the stenosed ICA, no significant differences were found for the rCBV or MTT between patients and control subjects. Also, no significant alterations in these two parameters were observed after CEA. In the hemisphere contralateral to the stenosed ICA, hemodynamic changes were observed only in patients with an ICA occlusion contralateral to the stenosed ICA. In these patients, rCBV, MTT, time of appearance, and time to peak were all increased in the contralateral hemisphere. After CEA, all hemodynamic parameters fell in the normal range. Conclusions-Although CEA does improve the cerebral circulation in patients with a severe stenosis and a contralateral ICA occlusion, the hemodynamic effects of CEA in patients with severe stenosis without a contralateral ICA occlusion are negligible. (Stroke. 1998;29:1567-1572.)

show abstract

Section: Discussionmentioning

confidence: 95%

“…Some studies did not report significant hemodynamic changes after CEA 7,16,17,19 ; other studies did find significant changes. 8,12 Other studies report that significant hemodynamic changes after CEA may occur in some but not all patients.…”

Section: Discussionmentioning

confidence: 99%

Long-Term Hemodynamic Effects of Carotid Endarterectomy

Kluytmans¹,

Eikelboom²,

Viergever³

1998

Stroke

View full text Add to dashboard Cite

show abstract

“…1 The degree of carotid stenosis correlates poorly with cerebral perfusion pressure, and several studies have been unable to detect any significant cerebral hemodynamic abnormality in a majority of patients with a high-grade CS. [2][3][4] Several other reports indicate the importance of cerebral hemodynamics in association with the risk of stroke in patients with CS or occlusion. [5][6][7][8] Carotid endarterectomy (CEA) improves the outcome of patients with symptomatic high-grade CS, 9 but its role in asymptomatic CS is less beneficial.…”

mentioning

confidence: 99%

Cerebral Hemodynamics in Asymptomatic and Symptomatic Patients With High-Grade Carotid Stenosis Undergoing Carotid Endarterectomy

Soinne

Helenius

Tatlısumak

et al. 2003

Stroke

View full text Add to dashboard Cite

Background and Purpose-Asymptomatic patients with carotid stenosis benefit less from carotid endarterectomy (CEA) than symptomatic patients because the risk of embolic events is lower, but it is not known whether the hemodynamic effect of CEA is different between the groups. We evaluated hemodynamics of symptomatic and asymptomatic patient groups before and after CEA. Methods-Forty-six independent patients with a unilateral high-grade carotid stenosis, 23 asymptomatic and 23 symptomatic, underwent dynamic susceptibility contrast MRI (DSC-MRI) and transcranial Doppler ultrasound (TCD) evaluation before CEA and 3 and 100 days afterward. Quantitative perfusion parameters were calculated separately in selected regions of white and gray matter and watershed regions in each hemisphere, and mean transit time (MTT) maps were assessed visually by 2 independent observers. Vasomotor reactivity was determined with breath-holding index and flow impedance with pulsatility index ipsilaterally. Results-In contrast to the asymptomatic carotid stenosis group, symptomatic carotid stenosis patients had preoperatively increased MTT and lower cerebral blood flow values in the ipsilateral hemisphere, more in white matter and watershed regions than in gray matter. Visually detected perfusion deficits were associated with symptomatic status. The interhemispheric asymmetries were abolished by CEA. The improving trend over time was greater in the symptomatic carotid stenosis group and was best seen in MTT. On TCD, pulsatility index was lower in symptomatic carotid stenosis patients preoperatively, with no postoperative difference, whereas the breath-holding index improved only in the symptomatic carotid stenosis group after CEA. Conclusions-Patients

show abstract

“…[5][6][7] Many studies have been conducted to evaluate hemodynamic and/or metabolic status in these patients, but the results are conflicting. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] We used positron emission tomography (PET) to assess the regional cerebral hemodynamics and metabolism in patients with severe symptomatic ICA stenosis before and after CEA.…”

mentioning

confidence: 99%