Gait improvement after carotid endarterectomy

Carotid endarterectomy (CEA) is known to be effective in reducing recurrent ischemic attacks, sometimes accompanied with the functional improvement, for patients with internal carotid artery (ICA) flow lesions by increase in perfusion and/or removal of embolic sources. However, the exact mechanism of how the CEA affects the cerebral metabolism in relations to the perfusion increase in noninfarcted hypoperfused peripheral areas to the center of the lesion (e.g., ischemic penumbra or border zone) is not yet clearly known. The existence of the ischemic penumbra and its long-term viability has also been argued. We designed a prospective study to investigate the metabolic changes in the ischemic penumbra for patients with ICA flow lesions and cerebral infarct (or ischemia) before and after CEA using localized in vivo proton magnetic resonance spectroscopy (1H-MRS). The results of 1H-MRS showed significantly decreased choline (Cho)/creatine (Cr) and increased N-acetylaspartate (NAA)/Cho ratios in the periphery of the lesion for the patients after CEA as compared to those who underwent only medical treatments. The more significant changes in the cerebral metabolite levels were observed in the patients who showed the improved cerebral perfusion by single photon emission computed tomography after CEA than in those who did not. In conclusion, our data suggest the existence of the ischemic penumbra, which were viable for a longer period than previously thought: CEA seems to improve the cerebral metabolism that may result from the improved perfusion at the ischemic penumbra.

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Comparison of Subjective and Objective Assessments on Improvement in Gait Function after Carotid Endarterectomy

Takahashi

Fujiwara

Igarashi

et al. 2020

Sensors

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The purpose of the present study was to determine whether objective gait test scores obtained using a tri-axial accelerometer can detect subjective improvement in gait as determined by the patient after carotid endarterectomy (CEA). Each patient undergoing CEA for ipsilateral internal carotid artery stenosis determined whether their gait was subjectively improved at six months after CEA when compared with preoperatively. Gait testing using a tri-axial accelerometer was also performed preoperatively and six months postoperatively. Twelve (15%) of 79 patients reported subjectively improved gait. Areas under the receiver operating characteristic curve for differences between pre- and postoperative test values in stride time, cadence, and ground floor reaction for detecting subjectively improved gait were 0.995 (95% confidence interval (CI), 0.945–1.000), 0.958 (95%CI, 0.887–0.990), and 0.851 (95%CI, 0.753–0.921), respectively. Cut-off points for value differences in detecting subjectively improved gait were identical to mean −1.7 standard deviation (SD) for stride time, mean +1.6 SD for cadence, and mean +0.4 SD for ground floor reaction of control values from normal subjects. Objective gait test scores obtained using the tri-axial accelerometer can detect subjective gait improvements after CEA. When determining significant postoperative improvements in gait using a tri-axial accelerometer, optimal cut-off points for each test value can be defined.

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Gait improvement after carotid endarterectomy

Cited by 3 publications

References 14 publications

Metabolic changes in the ischemic penumbra after carotid endarterectomy in stroke patients by localized in vivo proton magnetic resonance spectroscopy (H-MRS)

Metabolic changes in the ischemic penumbra after carotid endarterectomy in stroke patients by localized in vivo proton magnetic resonance spectroscopy (H-MRS)

Metabolic Changes in the Ischemic Penumbra after Carotid Endarterectomy in Stroke Patients by Localized in Vivo Proton Magnetic Resonance Spectroscopy (¹H-MRS)

Comparison of Subjective and Objective Assessments on Improvement in Gait Function after Carotid Endarterectomy

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Gait improvement after carotid endarterectomy

Cited by 3 publications

References 14 publications

Metabolic changes in the ischemic penumbra after carotid endarterectomy in stroke patients by localized in vivo proton magnetic resonance spectroscopy (H-MRS)

Metabolic changes in the ischemic penumbra after carotid endarterectomy in stroke patients by localized in vivo proton magnetic resonance spectroscopy (H-MRS)

Metabolic Changes in the Ischemic Penumbra after Carotid Endarterectomy in Stroke Patients by Localized in Vivo Proton Magnetic Resonance Spectroscopy (1H-MRS)

Comparison of Subjective and Objective Assessments on Improvement in Gait Function after Carotid Endarterectomy

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Product

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Metabolic Changes in the Ischemic Penumbra after Carotid Endarterectomy in Stroke Patients by Localized in Vivo Proton Magnetic Resonance Spectroscopy (¹H-MRS)