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Updated: Aug 16, 2026
Bilateral Common Carotid Artery Occlusion as an Adequate Preconditioning Stimulus to Induce Early Ischemic Tolerance to Focal Cerebral Ischemia
Published on: May 9, 2013
Bilateral brachial artery occlusion decreases internal carotid artery volume flow: a simple adjunct for cerebral
Vikram S Kashyap1, Kevin S Franklin, Colleen M Fitzpatrick
1Department of Vascular Surgery, Cleveland Clinic, Cleveland, Ohio 44195, USA. KASHYAV@ccf.org
Insights
Bilateral brachial artery occlusion transiently decreased internal carotid artery blood flow in some patients, potentially aiding cerebral protection devices. This maneuver may also noninvasively assess the circle of Willis integrity.
Area of Science:
- Vascular Surgery
- Neurology
- Medical Imaging
Background:
- Cerebral protection devices are crucial during carotid interventions.
- Optimizing cerebral blood flow management is essential for patient outcomes.
Purpose of the Study:
- To determine if bilateral brachial artery occlusion (BBO) reduces internal carotid artery (ICA) blood flow.
- To assess the potential of BBO to enhance cerebral protection during carotid interventions.
Main Methods:
- Thirty-two patients with carotid atherosclerosis underwent carotid duplex ultrasound.
- Volume flow rate (VF) in the ICA, ECA, and vertebral arteries was measured at baseline and during BBO.
- Neurological symptoms and circle of Willis completeness were evaluated.
Main Results:
- Seventeen patients (responders) showed a significant decrease in ICA VF during BBO (p=0.005).
- Responders exhibited increased external carotid artery (ECA) and vertebral artery VF.
- A complete circle of Willis was more common in responders (80%) than non-responders (16%).
Conclusions:
- BBO causes a transient decrease in ICA VF, with compensatory increases in ECA and vertebral VFs, particularly in individuals with a complete circle of Willis.
- This maneuver is insufficient for complete cerebral protection but may augment existing devices.
- Changes in ICA VF during BBO could serve as a noninvasive test for circle of Willis integrity.
Purpose:
To investigate if a decrease in internal carotid artery (ICA) blood flow occurs with bilateral brachial artery occlusion (BBO), which may improve the effectiveness of cerebral protection devices during carotid interventions.
Methods:
Thirty-two asymptomatic patients (21 men; mean age 67 years) with carotid atherosclerosis between 15% and 79% were enrolled in the study. Carotid duplex ultrasound was followed by volume flow rate (VF) determination in the right ICA, external carotid (ECA), and vertebral arteries. After baseline values were obtained, BBO was induced by bilateral arm pressure cuff inflation to 30 mmHg over the systolic pressure for no more than 3 minutes. VF measurements were repeated.
Results:
Seventeen patients (responders) had an ICA VF decrease from 406+/-109 mL/min (+/-SD) to 303+/-90 mL/min (p=0.005), while 15 patients (nonresponders) had no significant change in their ICA VF (340+/-192 versus 447+/-267 mL/min, p=0.22). In responders, ECA VF increased (190+/-65 to 232+/-125 mL/min), as did vertebral VF (77+/-53 to 95+/-60 mL/min; p>0.05). The ratio of ICA/ECA VF dropped from 2.13 to 1.31 in responders, but did not change in nonresponders. No patient exhibited any neurological symptoms during the study. Post cuff volume flows approximated baseline values. Cerebral magnetic resonance angiograms obtained in 10 responders revealed a complete circle of Willis in 8 (80%), while only 1 (16%) of 6 nonresponders had a complete pathway.
Conclusions:
A transient decrease in ICA VF, with concomitant elevations of the ECA and vertebral VFs, occurs with occlusion of the brachial arteries in the setting of a complete circle of Willis. Since no flow reversal occurs, this maneuver is insufficient to provide complete cerebral protection, but it may improve the effectiveness of cerebral protection devices and serve as an adjunctive maneuver in selected cases. Furthermore, changes in ICA VF may prove to be a noninvasive test for evaluating the integrity of the circle of Willis.
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