Intracranial hemodynamic stabilization patterns after stenting of severe stenosis in the proximal internal carotid
Jong Wook Shin1, Hye Seon Jeong, Hee-Jung Song
1Daejeon-Chungnam Regional Cardiovascular and Cerebrovascular Center, Chungnam National University Hospital and School of Medicine, Daejeon, South Korea.
Insights
Intracranial blood flow stabilization after carotid artery stenting (CAS) varies based on pre-procedure middle cerebral artery (MCA) flow. Patients with low pre-CAS MCA flow showed increased flow post-procedure, unlike those with high pre-CAS MCA flow.
Area of Science:
- Neurology
- Vascular Surgery
- Medical Imaging
Background:
- Carotid artery stenting (CAS) is a procedure to treat internal carotid artery stenosis.
- Intracranial hemodynamics and collateral circulation are crucial for cerebral blood supply.
- Understanding post-CAS hemodynamic stabilization is vital for patient outcomes.
Purpose of the Study:
- To evaluate intracranial hemodynamic stabilization patterns following CAS.
- To investigate the influence of pre-CAS collateral development on these patterns.
- To correlate pre-CAS middle cerebral artery (MCA) mean blood flow velocity (MBFV) with post-CAS hemodynamic changes.
Main Methods:
- Analysis of hemodynamic and angiographic data from 62 patients undergoing CAS.
- Transcranial Doppler examinations performed pre-CAS and at 1 and 90 days post-CAS.
- Patients categorized into low, normal, or high pre-CAS ipsilateral MCA MBFV groups.
Main Results:
- Lower pre-CAS collateral presence in the low MBFV group (17.6%) compared to normal (38.5%) and high (68.4%) groups.
- Low MBFV group showed increased MCA MBFV and pulsatility index (PI) post-CAS.
- High MBFV group demonstrated decreased MCA MBFV, with no PI change post-CAS.
- Normal MBFV group exhibited transient MCA MBFV increase and sustained PI increase post-CAS.
Conclusions:
- Post-CAS intracranial hemodynamic stabilization patterns are dependent on pre-CAS ipsilateral MCA MBFV.
- Pre-existing collateral status influences hemodynamic responses to CAS.
- Distinct hemodynamic stabilization trajectories exist for different pre-CAS flow velocity groups.
Purpose:
To evaluate intracranial hemodynamic stabilization patterns after carotid artery stenting (CAS) in patients having variable collateral developments before CAS.
Methods:
The hemodynamic and angiographic data of 62 patients (58 men; mean age 68.0±8.4 years) who underwent CAS for unilateral proximal internal carotid artery stenosis were analyzed. The patients had transcranial Doppler examinations before and at 1 and 90 days after CAS. Patients were classified according to pre-CAS mean blood flow velocity (MBFV) of the ipsilateral middle cerebral artery (MCA): low (<30 cm/s; n=17), normal (30 to 48 cm/s; n=26), or high (>48 cm/s; n=19). The collaterals from contralateral anterior and/or posterior circulations prior to CAS, the stabilization pattern of MBFV, and the pulsatility index (PI) after CAS were compared across the 3 groups.
Results:
The presence of collaterals was lowest in the low MBFV group (17.6% of patients) than in the normal (38.5%) or high (68.4%) MBFV groups (p=0.008). The low MBFV group exhibited an increase in MBFV and PI in the ipsilateral MCA at 1 and 90 days after CAS (p<0.05). By contrast, the high MBFV group exhibited a decrease in MBFV and no change in PI in the ipsilateral MCA up to 90 days after CAS (p<0.05). The normal MBFV group showed an increase in MBFV at post-CAS day 1 but a subsequent decrease at 90 days and an increase in PI in the ipsilateral MCA at 1 and 90 days post-CAS (p<0.05).
Conclusion:
The pattern of post-CAS intracranial hemodynamic stabilization differs according to the pre-CAS MBFV in the ipsilateral MCA.
