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Re-establishment of cerebral metabolism after carotid endarterectomy
R Balm1, J van der Grond, W P Mali
1Department of Vascular Surgery, University Hospital Utrecht, The Netherlands.
Objectives:
The purpose of this study was to evaluate the metabolic changes that occur in the human brain in patients with a symptomatic carotid artery stenosis.
Materials And Methods:
N-acetyl-aspartate (NAA), choline, creatine and lactate were measured both before, and 4 days after, carotid endarterectomy, by magnetic resonance spectroscopic imaging (MRSI). Eight controls and 16 patients were examined. MRI and MRSI studies were performed on a Philips Gyroscan S15 whole body system operating at 1.5 Tesla. 1H spectra were selected from regions in the centrum semi-ovale outside areas showing white matter hyper intensities on MRI.
Results:
All patients showed a decrease of the NAA/choline and NAA/creatine ratio in the symptomatic hemisphere compared to the contralateral hemisphere and also compared to the controls. Lactate was present in some patients (5/16). After endarterectomy, the NAA/choline and NAA/creatine ratios increased significantly compared to the ratios preoperative. Lactate was absent or more than 50% reduced after the operation. MRSI showed metabolic changes in areas of the brain that did not show any abnormalities on MRI.
Conclusions:
There are marked changes in brain metabolism in the symptomatic hemisphere of patients with a severe carotid artery stenosis. These metabolic changes normalise four days after endarterectomy.