Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow

The revascularization of carotid stenosis can increase ipsilateral cerebral blood flow (CBF). Occasionally, elevated CBF is also evident on the contralateral side, but this phenomenon is poorly understood.

To analyze retrospectively the relationship between a contralateral CBF increase and several clinical and radiologic features.

We retrospectively analyzed 40 patients with unilateral cervical carotid stenosis treated by carotid artery stenting (CAS). Using ¹²³I-iodamphetamine single-photon emission computed tomography (SPECT); we compared pre- and postoperative hemispheric CBF on both sides. We investigated the influence of the following five factors on the increase of the contralateral hemispheric CBF: stenosis grade (≥50% or <50%, according to the North American Symptomatic Carotid Endarterectomy Trial criteria); age; the presence of anterior and posterior communicating arteries; postoperative hyperperfusion on the stenotic side; and the presence of cerebral steal phenomenon during preoperative acetazolamide-challenge SPECT.

Following unilateral CAS, mean hemispheric CBF increased significantly on both sides: from 33.4±5.6 (mean ± SD) to 38.7±7.8 mL/min on the operated side (paired t test, p<0.001) and f35.4±5.4 to 39.2±7.2 mL/min on the contralateral side (p<0.001). In a general linear model, stenosis grade (≥50%) alone was significantly correlated with the increase of the CBF on the contralateral side (p=0.03).

Revascularization by CAS for unilateral carotid stenosis can increase hemispheric CBF on both sides. Increase of the contralateral CBF is correlated with stenosis grade (≥50%).