Analysis of Hemodynamic Changes in Early Stage after Carotid Stenting by Transcranial Doppler-A Preliminary Study
Ziguang Yan1, Min Yang1, Guochen Niu1
1Department of Interventional Radiology and Vascular Surgery, Peking University First Hospital, Beijing, China.
Insights
Carotid artery stenting (CAS) can increase blood flow in the ipsilateral middle cerebral artery (MCA) within 4 hours. This study used transcranial Doppler (TCD) to evaluate these early hemodynamic changes after CAS.
Area of Science:
- Neuroscience
- Vascular Surgery
- Medical Imaging
Background:
- Cerebral hyperperfusion syndrome and hemodynamic instability are known risks post-carotid artery stenting (CAS).
- Early hemodynamic changes within 6 hours after CAS are not well understood.
- This study investigates early cerebral hemodynamic changes following CAS using transcranial Doppler (TCD).
Purpose of the Study:
- To evaluate early post-procedure cerebral hemodynamic changes after carotid artery stenting (CAS).
- To assess changes in middle cerebral artery (MCA) peak systolic velocity (PSV) and pulsatility index (PI) using TCD within 4 hours post-CAS.
Main Methods:
- Retrospective review of 61 patients undergoing CAS from January 2013 to July 2014.
- TCD examinations performed on 44 patients before CAS and at 1-2 and 3-4 hours after CAS.
- Measurement of MCA PSV and PI on ipsilateral and contralateral sides, along with blood pressure monitoring.
Main Results:
- A significant increase in ipsilateral MCA PSV was observed 1-2 hours (19.9% increase) and 3-4 hours (18.2% increase) post-CAS.
- No significant difference in MCA PSV was found between the 1-2 hour and 3-4 hour post-CAS intervals.
- The pulsatility index (PI) in the ipsilateral MCA also showed a significant increase within 4 hours post-CAS.
- No significant MCA PSV increase was detected on the contralateral side.
Conclusions:
- Carotid artery stenting (CAS) can lead to significant increases in ipsilateral MCA PSV and PI within 4 hours.
- The observed increase in MCA PSV was significantly greater on the ipsilateral compared to the contralateral side.
- MCA PSV remained stable between 1-2 hours and 3-4 hours post-CAS.
Background:
Cerebral hyperperfusion syndrome or hemodynamic instability, caused by the hemodynamic changes, often occur within 6 hr after carotid artery stenting (CAS) The postprocedure cerebral hemodynamic change in the early phase, <6 hr after CAS, is largely unknown. In this study, we evaluated the cerebral hemodynamic changes in patients after CAS using transcranial Doppler (TCD).
Methods:
From January 2013 to July 2014, medical records of 61 patients who underwent CAS were reviewed retrospectively. Among them, 44 patients had TCD examination before CAS, 1-2 and 3-4 hr after CAS. In the TCD examination, middle cerebral artery (MCA) peak systolic velocity (PSV) and pulsatility index (PI) on the ipsilateral and contralateral sides were measured. Blood pressure, MCA PSV, and PI data were collected and analyzed from the 44 patients who had valid TCD examinations.
Results:
Blood pressure was 148.4 ± 14.5 mm Hg before CAS: 124.5 ± 13.8 mm Hg 1-2 hr after CAS, and 121.6 ± 12.6 mm Hg 3-4 hr after CAS. On the ipsilateral side, the MCA PSV increased from 85.7 ± 22.8 cm/s before CAS to 101.1 ± 27.1 cm/s (19.9%, P < 0.001) 1-2 hr after CAS, and 99.7 ± 27.0 cm/s (18.2%, P < 0.001) 3-4 hr after CAS. There was no significant difference in MCA PSV between 1-2 and 3-4 hr after CAS (P = 0.200). The PI increased from 0.871 ± 0.167 before CAS to 0.941 ± 0.205 (P = 0.022) 1-2 hr after CAS, and 0.954 ± 0.218 (P = 0.010) 3-4 hr after CAS. On the contralateral side, there was no statistically significant PSV increase in the MCA following CAS.
Conclusions:
CAS may induce a significant increase in PSV and PI in the ipsilateral MCA within 4 hr. The MCA PSV increased significantly higher than that on the contralateral side. The PSV had no significant change between 1-2 and 3-4 hr after CAS.
