Collateral cerebral vascular resistance in patients with significant carotid stenosis

This study tests, the hypothesis that asymptomatic patients with hemodynamically significant internal carotid artery stenosis have a lower ipsilateral collateral cerebral vascular resistance and hence greater blood flow than their symptomatic cohorts. We measured internal carotid artery blood flow and cerebral perfusion pressures intraoperatively prior to and after carotid endarterectomy in 35 symptomatic and 10 asymptomatic patients with hemodynamically significant internal carotid artery stenosis. When the stenosis produced 30% or greater reduction in blood flow the calculated nondimensional normalized ratio of collateral cerebral vascular resistance of ipsilateral hemisphere cerebral vascular resistance was 1.15 +/- 0.83 (mean +/- SD) for the 10 asymptomatic patients and 2.98 +/- 1.89 for the 35 symptomatic patients (p = 0.0044). For the subgroup of 22 patients with 50% or greater reduction in internal carotid artery blood flow the resistance ratios were 0.782 +/- 0.541 for the 5 asymptomatic patients and 3.21 +/- 2.26 for the 17 symptomatic patients (p = 0.029). These results suggest that asymptomatic patients with hemodynamically significant internal carotid artery stenoses have a lower collateral cerebral vascular resistance than their symptomatic cohorts. The low collateral resistance may provide an adequate collateral cerebral blood flow to prevent ischemia and symptoms.