Intracranial Blood Flow Changes in Patients with High-Grade Severe Carotid Artery Stenosis After Stenting
Lei Huang1, Wenjie Cao2, Liang Ge1
1Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
Insights
Carotid artery stenting improves brain blood flow differently based on stenosis severity. High-grade severe stenosis patients showed significant cerebral blood flow increases and normalized collateral flow post-stenting.
Area of Science:
- Neurology
- Vascular Surgery
- Radiology
Background:
- Severe carotid stenosis poses a risk for ischemic stroke.
- Carotid artery stenting (CAS) is a treatment option for severe carotid stenosis.
- Cerebral hemodynamic changes after CAS may vary with stenosis severity.
Objective:
We investigated whether the cerebral hemodynamic changes of pre- and poststenting in patients with severe carotid stenosis differ by stenosis grades.
Methods:
We prospectively recruited patients who underwent carotid artery stenting (CAS) after acute ischemic stroke from June 2014 to December 2015. We compared the mean relative cerebral blood flow (rCBF) changes (measured by whole-brain computed tomography perfusion) pre- and poststenting in patients with high-grade severe stenosis (HGSS) (90%-99%) versus patients with low-grade severe stenosis (LGSS) (70%-89%).
Results:
Among 24 patients included in the study (mean age, 66.2 ± 7.2 years; 91.7% men), 62.5% (15/24) were in the HGSS group and 37.5% (9/24) were in the LGSS group. In the HGSS group, rCBF increased in territories of the anterior cerebral artery (P = 0.021), middle cerebral artery (P < 0.001), posterior cerebral artery (P = 0.001), and basil ganglia (P = 0.003) after stenting. Of the patients with HGSS, 53.3% (8/15) had collateral flow through anterior communicating artery (AcomA) prestenting. After stenting, all the AcomA collaterals in HGSS reverted to normal (P = 0.002).
Conclusions:
The improvement of brain perfusion combined with the normalization of collateral flow through the circle of Willis after CAS was observed only in patients with HGSS.
