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Cerebrovascular reactivity before and after carotid endarterectomy
V D'Angelo1, G Catapano, V Bozzini
1Department of Neurosurgery, Casa Sollievo della Sofferenza Hospital, IRCCS, S. Giovanni Rotondo (FG), Italy.
Insights
Cerebrovascular reactivity (CVR) effectively assesses hemodynamic impairment in internal carotid artery stenosis. Carotid endarterectomy significantly improves CVR, restoring normal cerebral blood flow.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Imaging
Background:
- Anatomic features of internal carotid artery (ICA) stenosis do not always correlate with hemodynamic significance.
- Cerebrovascular reactivity (CVR) is a proposed method to assess cerebral hemodynamic impairment.
Purpose of the Study:
- To evaluate the role of CVR in assessing hemodynamic relevance of ICA stenosis.
- To determine the effectiveness of carotid endarterectomy in restoring CVR.
Main Methods:
- Assessed pre- and postoperative CVR using CO2 transcranial Doppler in 25 patients with high-grade ICA stenosis.
- Excluded patients with stroke history, cerebral infarction, or brainstem/contralateral symptoms.
- Utilized statistical analysis to evaluate CVR changes post-carotid endarterectomy.
Main Results:
- Preoperative CVR correlated with ICA stenosis degree and contralateral steno-occlusion.
- Mean preoperative CVR was 66.5% (moderately reduced).
- Mean postoperative CVR was 84.1% (normal), showing statistically significant improvement.
Conclusions:
- CVR evaluation provides clinically relevant hemodynamic information in ICA stenosis patients.
- Carotid endarterectomy effectively restores CVR in patients with cerebral hemodynamic impairment.
Background:
The hemodynamic relevance of internal carotid artery (ICA) stenosis often does not correlate with anatomic features, as angiographically defined. The cerebrovascular reactivity (CVR) has been advocated as a means of defining the cerebral hemodynamic impairment.
Methods:
We assessed the results of pre- and postoperative CVR evaluation, using the CO2 transcranial doppler method, in 25 patients with high-grade ICA stenosis. The patients with history of stroke, evidence of cerebral CT infarction or symptoms from the contralateral circulation or the brain stem were excluded to avoid the effects of cerebral infarction on the hemodynamic studies. Statistical analysis was used to evaluate the CVR changes after carotid endarterectomy.
Results:
Preoperative evaluation showed that CVR was generally well correlated with the degree of ICA stenosis and concomitant contralateral carotid steno-occlusion. Before endarterectomy the mean CVR value was 66.5% (moderately reduced). After surgery the overall mean value of CVR was 84.1% (normal), with a statistically significant improvement.
Conclusion:
The results of this study suggest that the CVR evaluation allows one to obtain hemodynamic information of clinical interest in the patients with ICA stenosis and that carotid endarterectomy is effective to restore the CVR in patients with cerebral hemodynamic impairment.