Related Experiment Video
Updated: Jun 23, 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
Ischemic events after carotid interventions in relationship to baseline cerebrovascular reactivity
George K C Wong1, Stephanie C P Ng, Matthew T V Chan
1Division of Neurosurgery, The Chinese University of Hong Kong, Hong Kong, China.
Insights
Impaired cerebrovascular reactivity did not predict stroke risk after carotid intervention. This suggests cerebrovascular reactivity testing may not guide aggressive treatment decisions for patients with carotid stenosis.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Imaging
Background:
- Cervical carotid stenosis poses a significant risk for ischemic events.
- Predicting stroke risk after intervention is crucial for patient management.
Purpose of the Study:
- To determine if baseline cerebrovascular reactivity predicts ischemic events post-carotid intervention.
- To identify patient subgroups benefiting from aggressive management based on cerebrovascular reactivity.
Main Methods:
- Retrospective review of patients with >70% carotid stenosis undergoing carotid endarterectomy or angioplasty/stenting.
- Baseline cerebrovascular reactivity assessed using Transcranial Doppler ultrasonography with CO2 challenge.
- Mean follow-up of 66 months.
Main Results:
- Four ischemic events occurred during follow-up among all patients.
- No ischemic events were observed in the nine patients with impaired baseline ipsilateral cerebrovascular reactivity.
- The study included 26 symptomatic and 10 asymptomatic carotid stenosis patients.
Conclusions:
- Impaired baseline cerebrovascular reactivity did not predict subsequent stroke risk after carotid intervention.
- Cerebrovascular reactivity testing may not be a reliable indicator for intensifying medical or surgical treatments in this context.
Background:
We aimed to investigate whether baseline cerebrovascular reactivity could predict subsequent ischemic event after intervention and identify the patient group for more aggressive medical and interventional management paradigms.
Methods:
Patients with more than 70% cervical carotid stenosis (from ultrasonography) were reviewed. Patients, who had baseline cerebrovascular reactivity test before intervention and had either carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS) performed, were recruited for analysis. Transcranial Doppler ultrasonography was used to examine the reactivity of the middle cerebral artery in response to 5% carbon dioxide in oxygen. The mean follow up period was 66 months.
Findings:
Twenty-six patients had symptomatic carotid stenosis and ten patients had asymptomatic carotid stenosis. There were four subsequent ischemic events during follow up. None of the nine patients with impaired baseline ipsilateral cerebrovascular reactivity had subsequent ischemic event.
Conclusions:
In this current study, impaired baseline cerebrovascular reactivity did not predict the subsequent stroke risk after carotid intervention. Cerebrovascular reactivity testing may not serve as an indicator for aggressive medical and surgical treatments.
Related Concept Videos
01:15Ischemic Stroke l: Introduction
01:26Transient Ischemic Attack l: Introduction
01:15Ischemic Stroke ll: Pathophysiology