Increased cerebral blood flow after external carotid artery revascularization

Area of Science:

• Vascular Surgery
• Neurology
• Radiology

Background:

• Internal carotid artery (ICA) occlusion can lead to cerebral ischemia.
• External carotid artery (ECA) stenosis or occlusion may coexist, impacting cerebral blood flow.
• Limited treatment options exist for symptomatic ICA occlusion with ECA compromise.

Purpose of the Study:

• To evaluate the efficacy of external carotid artery (ECA) revascularization in patients with internal carotid artery (ICA) occlusion and ECA disease.
• To assess the impact of ECA revascularization on cerebral blood flow (CBF) using Xenon-133 (133Xe) scintigraphy.
• To determine the effectiveness of ECA revascularization in relieving symptoms of cerebral ischemia.

Main Methods:

• Retrospective analysis of 10 patients with symptomatic ICA occlusion and ECA stenosis/occlusion.
• Surgical intervention included external carotid endarterectomy or saphenous vein bypass to the ECA.
• Cerebral blood flow (CBF) was measured using Xenon-133 (133Xe) in six patients preoperatively and five postoperatively.

Main Results:

• Postoperative CBF significantly improved (15-39%) on the treated side in all five assessed patients.
• Four patients showed contralateral CBF improvement (12-52%).
• Nine out of ten patients experienced symptom relief; one required subsequent extracranial-intracranial bypass.

Conclusions:

• External carotid artery (ECA) revascularization is an effective treatment for increasing total and regional cerebral blood flow (CBF) in selected patients.
• ECA revascularization successfully alleviates symptoms associated with internal carotid artery (ICA) occlusion and ECA stenosis.
• Xenon-133 (133Xe) scintigraphy is a valuable tool for preoperative patient selection and objective assessment of surgical outcomes.