Immediate Regression of Leukoaraiosis after Carotid Artery Revascularization

Abstract

Background: Leukoaraiosis (LA) affects cognition after stroke and reversal of LA may improve cognitive performance. We aimed to determine the impact of cerebral perfusion and circle of Willis (CoW) flow patterns on the extent of LA after carotid artery revascularization. Methods: LA was scored on fluid-attenuated inversion recovery magnetic resonance (MR) images at the levels of the centrum semiovale and frontal horns in both cerebral hemispheres of 62 contiguous patients (men/women = 38/24, mean age = 63.2 ± 8.4 years, range 44–82) before and after unilateral carotid artery revascularization. The pre- and poststenting differences in LA scores, CoW flow pattern on MR angiography, and MR perfusion parameters were analyzed. Results: The total LA score decreased from 9.87 ± 0.65 to 8.33 ± 0.72 after stenting (p = 0.03). The CoW was complete in 21 subjects and incomplete in 41 subjects. The incomplete CoW group had a higher preoperative LA load and higher cerebral interhemispheric asymmetry index, both of which decreased significantly postoperatively. Conclusions: CoW anomalies may contribute to LA in patients with carotid artery stenosis, and restoration of cerebral perfusion by carotid artery revascularization can reduce LA severity.

The Circle of Willis and White Matter Lesions in Patients with Carotid Atherosclerosis

“…However, the correlation of leukoaraiosis with cerebral atherosclerosis is not ascertained, and conflicting conclusions have been reported. [16][17]19,21 In our study, we did not find the association between the severe carotid atherosclerosis and WMLs in periventricular and deep white matter. The results supported that WMLs are not correlated with atherosclerosis and may be one type of small-vessel disease.…”

“…5,19,20 Recent study even indicated that carotid artery revascularization could reduce the severity of leukoaraiosis. 21 Chronic cerebral hypoperfusion due to arterial stenosis may be the underlying mechanism of WMLs. It also could induce the collateralization.…”

Ophthalmic Artery Flow and Cognitive Performance in Patients with Carotid Artery Stenosis

“…Restoration of cerebral perfusion by carotid revascularization can reduce the severity of leukoaraiosis [18]. Although the OA flow direction is sensitive to the overall cerebral perfusion condition, whether the reconstitution of cerebral perfusion through reversed OA flow is adequate to maintain cognitive function or can be employed as a surrogate marker of cognitive impairment remains elusive.…”

Changes of neurocognitive cerebral functions in patients after aortic arch and brachiocephalic arteries surgery (review)

“…Когнитивная послеоперационная дисфункция -од-на из серьезнейших проблем современной реабилитации пациентов после кардиохирургических и сосудистых опе-раций во всем мире [4,[7][8][9][10]. Операции на дуге аорты (ДА) выполняют по жизненным показаниям при абсо-лютной бесперспективности консервативного лечения, в то время как хирургия брахицефальных артерий (БА) при-звана сократить частоту фатального и грубого очагового поражения центральной нервной системы (ЦНС).…”

“…Y. Chuang и соавт. [10] с по-мощью МРТ и ангиографии сравнили размеры зон лейко-ареоза у 62 пациентов, перенесших инсульт ГМ, до стен-тирования и в ближайшем послеоперационном периоде. Авторы выявили зависимость замкнутости виллизиева круга на факт развития инсульта у пациентов с унилате-ральным стенозом внутренней сонной артерии, а также продемонстрировали, что уменьшение старых зон лейко-ареоза происходит сразу после операции.…”