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Dynamic Cerebral Autoregulation After Carotid Endarterectomy
Zi-Duo Shen1, Yang Qu1, Peng Zhang2
1Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
Insights
Dynamic cerebral autoregulation (dCA) in carotid artery stenosis patients improves one month after carotid endarterectomy (CEA), not immediately. This suggests stroke risk is higher acutely post-CEA, with benefits appearing later.
Area of Science:
- Neurology
- Vascular Surgery
- Cerebrovascular Physiology
Background:
- Dynamic cerebral autoregulation (dCA) is impaired in severe internal carotid artery (ICA) stenosis.
- Carotid endarterectomy (CEA) may improve dCA, but the post-operative time course is unclear.
Purpose of the Study:
- To investigate the effects of CEA on dCA in patients with carotid artery stenosis at different time points post-surgery.
Main Methods:
- Prospective study of 44 CEA patients and 44 controls.
- dCA measurements (phase difference, gain) at baseline, 3 days, and 1 month post-CEA.
- Analysis of dCA changes before and after CEA.
Main Results:
- Patients with ICA stenosis had lower bilateral phase difference (PD) than controls.
- PD did not improve within 3 days post-CEA.
- Affected-side PD significantly improved 1 month post-CEA, reaching control levels.
Conclusions:
- dCA does not improve immediately after CEA but shows significant improvement at 1 month.
- Stroke risk and complications like cerebral hyperperfusion syndrome are concerns in the acute post-CEA period.
Objective:
Studies have shown that dynamic cerebral autoregulation (dCA) is impaired in patients with severe internal carotid artery (ICA) stenosis and that carotid endarterectomy (CEA) may improve dCA in these patients. However, the time course of dCA changes in patients after CEA remains unclear. Therefore, this study aimed to investigate the effects of CEA on the dCA in patients with carotid artery stenosis at different time points.
Methods:
This prospective study enrolled 44 patients (19 symptomatic stenosis patients and 25 asymptomatic stenosis patients) who underwent CEA and 44 age- and sex-matched controls. In the CEA group, the patients underwent dCA measurements at baseline, within 3 days, and 1 month after CEA. Transfer function parameters, phase difference (PD), and gain were used to quantify dCA. Changes in dCA before and after CEA were analyzed in detail.
Results:
The bilateral PD of the patients before CEA was significantly lower than that of the control group. This damage did not improve within 3 days after surgery. One month after surgery, the PD on the affected side of the patients significantly improved compared with before surgery and reached the level of the control group. The PD of affected side across time points in symptomatic and asymptomatic stenosis patients is consistent with that in all patients.
Conclusions:
The dCA level did not improve immediately after CEA but significantly improved 1 month after surgery. This suggests that the occurrence of stroke should be considered in the acute period after CEA surgery, and its preventive effect on stroke may be effective after 1 month.Clinical ImpactWe found the dCA level did not improve immediately after CEA but significantly improved 1 month after surgury. This suggests that the occuttencce of stroke and surgical complications (such as cerebral hyperperfusion syndrome) associated with impaired dCA in the acute phase after CEA surgery should be of particular concern.
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