Cerebral hemodynamics and baroreflex sensitivity after carotid artery stenting
Insights
Carotid angioplasty and stenting (CAS) improves cerebral blood flow, but baroreflex sensitivity (BRS) takes six months to normalize. This study tracked hemodynamic changes after CAS in stroke patients.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Imaging
Background:
- Long-term hemodynamic effects of carotid angioplasty and stenting (CAS) remain unclear.
- Cerebral hemodynamics are crucial for patients with cerebrovascular disease.
Purpose of the Study:
- To investigate longitudinal changes in cerebral hemodynamics after CAS.
- To assess the impact of CAS on cerebral blood flow and autonomic function.
Main Methods:
- Prospective evaluation of 63 symptomatic male patients undergoing CAS.
- Transcranial color-coded Doppler (TCCD) ultrasonography to measure mean blood flow velocities (MBFV) and pulsatility index (PI) of middle cerebral arteries (MCA).
- Baroreflex sensitivity (BRS) measured to assess cardiac autonomic activity at baseline and 1, 3, 6, and 12 months post-CAS.
Main Results:
- Ipsilateral MCA MBFV and PI were lower pre-CAS but increased significantly post-CAS, stabilizing after 2 weeks.
- A nonsignificant increase in contralateral MCA MBFV was observed.
- BRS decreased significantly at 1 month post-CAS, returning to baseline by 6 months.
Conclusions:
- CAS improves global cerebral hemodynamic status in patients.
- Autonomic function, indicated by BRS, shows delayed normalization after CAS, reaching baseline at 6 months.
Objectives:
The long-term hemodynamic effects of carotid angioplasty and stenting (CAS) are unclear. We performed a longitudinal study to investigate the variations in cerebral hemodynamics in patients undergoing CAS.
Materials And Methods:
We performed prospective evaluation of 63 symptomatic male patients (19 patients had transient ischemic attack and 44 had minor stroke; mean age: 77.3 ± 6.3 years [range: 51-86]). The mean blood flow velocities (MBFV) and pulsatility index (PI) of the middle cerebral arteries (MCA) on both sides were evaluated using transcranial color-coded Doppler (TCCD) ultrasonography. Cardiac autonomic activities were evaluated by measuring baroreflex sensitivity (BRS). All parameters were measured at baseline prior to CAS and at 1, 3, 6, and 12 months after CAS.
Results:
The preoperative MBFV and PI of the ipsilateral MCA were significantly lower than those of the contralateral side. However, after CAS, MBFV in the ipsilateral MCA increased significantly until 2 weeks after stenting, after which the MBFV gradually decreased and remained stable for 1 year after CAS. Further, we observed a nonsignificant increase in MBFV in the contralateral MCA after CAS. In contrast to the MBFV, the BRS values decreased significantly 1 month after stenting and returned to baseline levels 6 months after CAS.
Conclusions:
Patients with CAS showed improved global cerebral hemodynamic status. However, the BRS did not normalize initially, and baseline value was achieved at 6 months after stenting.
