Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow

Sadato, Akiyo; Maeda, Shingo; Hayakawa, Masayuki; Adachi, Kazuhide; Toyama, Hiroshi; Nakahara, Ichirō; Hirose, Yuichi

doi:10.1136/neurintsurg-2017-013193

Cited by 14 publications

(7 citation statements)

References 11 publications

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“…More and more studies have confirmed that cerebral vascular stenosis first leads to hypoperfusion in the perfusion territory, while increasing cerebral collateral circulation to compensate for impaired cerebral blood flow, and carotid endarterectomy and carotid stent can significantly improve rCBF Fig. 1 The cubic simulation curve between TSS and GBF (a), and between RI-TSS and GBF (b) in the perfusion territory [14][15][16]. However, the effects of these local vascular stenosis on GBF and the relationship between degree of carotid stenosis and GBF have not been reported.…”

Section: Discussionmentioning

confidence: 98%

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

Tang

Wang

et al. 2020

Neurol Sci

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Introduction To improve the accuracy of ultrasound techniques for the assessment of carotid stenosis, we designed a novel carotid artery stenosis ultrasound scale (CASUS), and evaluated its accuracy, reliability, and its value in predicting the occurrence of cardiovascular and cerebrovascular diseases in a prospective study. Methods A total of 750 patients with first-time ischemic stroke and hospitalized within 24 h were enrolled in the study. Using color Doppler ultrasound (CDUS), the degree of stenosis and blood flow (BF) in bilateral internal carotid arteries (ICA) and the V1-V3 segment of vertebral arteries (VA) was assessed. Cubic simulation curves for BF and global blood flow (GBF) over the stenosis score (SS), total stenosis score (TSS), and radiological imaging-total stenosis score (RI-TSS) were fitted and compared. The receiver operating characteristic (ROC) curves using TSS, RI-TSS, or GBF to predict various ischemic stroke endpoints were also analyzed and compared. Results There was a linear relationship between SS and BF both ICA and VA (R2 were 0.734 and 0.783, respectively, both P < 0.05). Both TSS and RI-TSS with GBF showed an inverse "S" curve relationship (R2 was 0.839 and 0.843, all P < 0.05). The AUC values of TSS-based and RI-TSS-based predictions of each endpoint were all greater than 0.7 (all P < 0.05), but the differences of the AUC values between TSS, RI-TSS, and GBF were not statistically significant (all P > 0.05). Conclusions The novel CASUS can better reflect the level of cerebral reperfusion in patients with ischemic stroke and can better predict the occurrence of cardiovascular and cerebrovascular diseases. Keywords Brain ischemic. Carotid stenosis. Ultrasound. Neuroimaging. Cerebral blood flow Yi Tang and Ming-yu Wang contributed equally to this work.

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Section: Discussionmentioning

confidence: 98%

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

Tang

Wang

et al. 2020

Neurol Sci

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“…In contrast, a statistically significant increase in vessel density was observed in both the SVC and DVC in the fellow eye group. Previous studies demonstrated that unilateral carotid revascularization may improve cerebral blood flow and metabolism not only in the ipsilateral hemisphere but also in the contralateral hemisphere 17–19 . The improvements in bilateral retrobulbar ocular blood flow and electrophysiological responses of the retina were also identified 20,21 .…”

Section: Discussionmentioning

confidence: 99%

Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting

Lee

Cheng

Chang

et al. 2019

Sci Rep

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The aim of the study was to evaluate the influence of carotid angioplasty and stenting (CAS) on retinal microvasculature using optical coherence tomography angiography (OCTA) in patients with severe carotid stenosis. 20 patients with severe carotid stenosis underwent comprehensive ophthalmic examinations and OCTA before and one month after CAS. Automated algorithms were used to quantify vessel density in the macular superficial vascular complex (SVC), deep vascular complex (DVC), and radial peripapillary capillary (RPC) around the optic disc. Eyes on the operated side constituted the ipsilateral eye group, and the other eye constituted the fellow eye group. In the ipsilateral eye group, the vessel density in the DVC increased significantly after stent implantation (P = 0.010), but the vessel density change in the SVC was not statistically different (P = 0.999). In the fellow eye group, the vessel density in the SVC (P = 0.028) and DVC (P = 0.034) were significantly increased after stent implantation. The vessel density in the RPC did not significantly change in the ipsilateral (P = 0.363) or fellow (P = 0.878) eye groups. This study shows that unilateral CAS for severe carotid stenosis increases macular vessel densities in both eyes.

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“…We speculate that increased contralateral leptomeningeal flow towards the occluded side may have caused cSAH. The establishment of collateral circulation can lead to hemodynamic changes on the contralateral side and leptomeningeal anastomoses on the cerebral surface may have served as a link for this increase in cerebral blood flow [17]. Moreover, occlusion on the ischemic side may have led to the dilatation of the contralateral vasculature as a compensatory mechanism.…”

Section: Discussionmentioning

confidence: 99%

Acute ischemic stroke with contralateral convexal subarachnoid hemorrhage: two cases report

Cao

et al. 2019

BMC Neurol

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Background Convexal subarachnoid hemorrhage (cSAH) is characterized by isolated bleeding in one or a few adjacent sulci and has diverse etiologies and symptoms. Acute ischemic stroke co-occurring with cSAH has been infrequently reported. Nearly all cases of cSAH have been described to occur on the side with acute ischemic stroke, and it is unusual for cSAH to occur on the opposite side of the infarct territory. Case presentation Our report presents two cases of acute ischemic stroke associated with contralateral cSAH. The first patient had left atherosclerotic internal carotid artery (ICA) occlusion with developing right parietal cSAH. The other patient developed left parietal cSAH in the setting of right ICA occlusion caused by cardiogenic embolism with acute right cerebral hemisphere infarction. Both patients remained clinically stable with good prognosis after antithrombotic treatment. Conclusions Our report suggest that cSAH may simultaneously occur on the opposite side of an infarction. Although there is no consensus on the etiology and treatment of this rare phenomenon, cSAH did not lead to a poor outcome in our patients.

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Carotid stenting for unilateral stenosis can increase contralateral hemispheric cerebral blood flow

Abstract: Revascularization by CAS for unilateral carotid stenosis can increase hemispheric CBF on both sides. Increase of the contralateral CBF is correlated with stenosis grade (≥50%).

Cited by 14 publications

References 11 publications

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

The role of carotid stenosis ultrasound scale in the prediction of ischemic stroke

Optical Coherence Tomography Angiography Evaluation of Retinal Microvasculature Before and After Carotid Angioplasty and Stenting

Acute ischemic stroke with contralateral convexal subarachnoid hemorrhage: two cases report

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