Hemodynamic effect of carotid stenting and carotid endarterectomy
Peter Jan van Laar1, Jeroen van der Grond, Frans L Moll
1Department of Radiology, University Medical Center Utrecht, Utrecht, The Netherlands. p.j.vanlaar@azu.nl
Insights
Carotid angioplasty with stent placement (CAS) normalizes cerebral blood flow, similar to carotid endarterectomy (CEA). This study shows CAS effectively restores hemodynamics in patients with internal carotid artery stenosis.
Area of Science:
- Vascular Surgery
- Neurology
- Medical Imaging
Background:
- Carotid angioplasty with stent placement (CAS) is an alternative to carotid endarterectomy (CEA).
- The impact of CAS on cerebral hemodynamics is not well understood.
- CEA is known to normalize cerebral hemodynamics.
Purpose of the Study:
- To investigate the effects of CAS on cerebral hemodynamics.
- To compare CAS outcomes with CEA and control subjects.
Main Methods:
- Prospective study of 23 patients undergoing CAS for symptomatic internal carotid artery (ICA) stenosis.
- Magnetic resonance volume flow quantification of ICAs and basilar artery (BA) before and 1 month after CAS.
- Comparison with 13 patients undergoing CEA and 40 controls.
Main Results:
- CAS significantly increased ipsilateral ICA volume flow and total cerebral volume flow.
- Total volume flow and stenosed ICA flow normalized post-CAS compared to controls.
- Improvements in volume flow after CAS were comparable to those seen after CEA.
Conclusions:
- CAS effectively normalizes impaired cerebral hemodynamics.
- Magnetic resonance volume flow measurements confirm hemodynamic improvement.
- The hemodynamic benefits of CAS are similar to those of CEA.
Background:
Carotid angioplasty with stent placement (CAS) may offer an alternative treatment to carotid endarterectomy (CEA). However, in contrast to CEA, which has been shown to normalize impaired cerebral hemodynamics, the effects of CAS remain unclear. To investigate alterations in cerebral hemodynamics, we prospectively studied patients undergoing CAS and compared them with a group of similar patients undergoing CEA.
Methods:
Twenty-three patients undergoing CAS for recently symptomatic internal carotid artery (ICA) stenosis were prospectively studied. Volume flow in the ICAs and basilar artery (BA) were measured with magnetic resonance volume flow quantification before CAS and 1 month after. The results were compared with those in 13 similar patients undergoing CEA and 40 control subjects without ICA stenosis.
Results:
After CAS, volume flow in the ipsilateral ICA increased from 114 +/- 17 to 231 +/- 17 mL/min (P < .001), and total volume flow (ICAs plus BA) increased from 495 +/- 24 to 552 +/- 28 mL/min (P < .05). No significant changes were seen in the contralateral ICA and BA after CAS. Total volume flow and flow in the stenosed ICA normalized after CAS compared with control subjects. Volume flow values similarly improved after CEA.
Conclusions:
CAS results in a normalization of impaired cerebral hemodynamics, as assessed by magnetic resonance volume flow measurements. The degree of improvement is similar to that seen after CEA.
