Cerebral hemodynamic monitoring in the early stage after simultaneous bilateral carotid artery stenting

There is a growing concern regarding the risk of cerebral hyperperfusion syndrome (CHS) associated with simultaneous bilateral carotid artery stenting (SBCAS). This retrospective, single-center, observational cohort study aimed to compare early cerebral hemodynamic changes between patients treated with SBCAS and those treated with unilateral carotid artery stenting (UCAS) through the use of transcranial color-coded Doppler (TCCD).

Data from 25 patients who underwent SBCAS and 165 patients who underwent UCAS between June 2013 and June 2023 were analyzed. TCCD monitoring was conducted for all patients prior to and 1 hour following the carotid artery stenting (CAS) procedure. A propensity score matching (PSM) method was employed to match patients from the SBCAS and UCAS groups in a 1:2 ratio. Key parameters compared between groups included middle cerebral artery peak systolic velocity (MCA-PSV), pulsatility index, blood pressure, and complications.

A statistically significant increase in ipsilateral MCA-PSV was detected in both the SBCAS group (35% increase; from 78±25 to 105±22 cm/s; P<0.001) and the UCAS group (27% increase; from 79±23 to 100±28 cm/s; P<0.001). Notably, the increase in ipsilateral MCA-PSV in the SBCAS group was substantially greater than that in the UCAS group (35% vs. 27%; P=0.043). Three and four cases of cerebral hyperperfusion (CHP) were identified in the SBCAS group and the UCAS group, respectively. Only one case of CHS was recorded in the UCAS group. A total of 22 patients in the PSM SBCAS group and 34 patients in the PSM UCAS group were analyzed. The increase in ipsilateral MCA-PSV in the PSM SBCAS group was significant, higher than that in the PSM UCAS group (48% vs. 31%; P=0.031). However, no significant differences in the incidence of CHP were found between the two groups.

The increase in ipsilateral MCA-PSV was significantly greater in the SBCAS group than in the UCAS group. The risk of CHP and CHS was not higher in the SBCAS group as compared to the UCAS group. The use of TCCD post-CAS may be beneficial in monitoring and potentially preventing CHS, particularly in patients undergoing SBCAS, and is therefore recommended.