Cerebrovascular reactivity before and after carotid endarterectomy

D’Angelo, Vincenzo; Catapano, Giuseppe; Bozzini, V.; Catapano, Domenico; Vivo, P. De; Ciritella, P; L, Parlatore

doi:10.1016/s0090-3019(97)00503-x

Cited by 13 publications

(12 citation statements)

References 23 publications

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“…[35][36][37] In some patients in this study, family members reported such improvements after CEA, although the patients underwent no objective psychological tests. Our findings agree with some previous studies, [8][9][10][11][12][13][14][15][16][17] but are in conflict with other reports. 7,18-21 For example, Kluytmans et al 19 observed hemodynamic compromise only in cases of occlusion of the contralateral ICA in patients with ipsilateral ICA stenosis Ͼ 70% using dynamic susceptibility contrast magnetic resonance imaging (MRI).…”

Section: Discussionsupporting

confidence: 70%

“…Although we cannot substantiate the amount of collateral flow in individual patients, 7,20 it is possible that the collateral flow in our cases was poorer than those in the previous series, because the stump pressure of ICA during surgery was 34.7 Ϯ 3 mm Hg. Third, the modality of measurements should be considered; various technologies were used in previous studies, including transcranial Doppler sonography, [8][9][10][11][12]18 single photon emission computed tomography, 16,17,20 and MRI. [13][14][15]19 However, because these techniques cannot necessarily provide quantitative and/or regional hemodynamic or metabolic information of the brain, comparisons with the patients and control subjects are difficult.…”

Section: Discussionmentioning

confidence: 99%

“…[5][6][7] Many studies have been conducted to evaluate hemodynamic and/or metabolic status in these patients, but the results are conflicting. [7][8][9][10][11][12][13][14][15][16][17][18][19][20][21][22][23][24][25][26] We used positron emission tomography (PET) to assess the regional cerebral hemodynamics and metabolism in patients with severe symptomatic ICA stenosis before and after CEA.…”

mentioning

confidence: 99%

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Hemodynamic and Metabolic Changes After Carotid Endarterectomy in Patients With High-Degree Carotid Artery Stenosis

Hino

Horikawa

Fujimoto

et al. 2005

Journal of Stroke and Cerebrovascular Diseases

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Section: Discussionsupporting

confidence: 70%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Hemodynamic and Metabolic Changes After Carotid Endarterectomy in Patients With High-Degree Carotid Artery Stenosis

Hino

Horikawa

Fujimoto

et al. 2005

Journal of Stroke and Cerebrovascular Diseases

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“…This is primarily expected from contralateral CEA and is in agreement with data from the literature. 13,[37][38][39] The bilateral improvement of cerebral vasoreactivity that we found in operated patients may be an important effect of contralateral CEA because this could be related to a lower risk of recurrent cerebral ischemia. 40,41 It should be noted that the difference in time course of CO 2 reactivity between operated and nonoperated patients may partly be explained by the fact that reactivity was initially lowest in operated patients; postoperative increase of CO 2 reactivity may be more pronounced in patients with low CO 2 reactivity.…”

Section: Discussionmentioning

confidence: 71%

Sustained Bilateral Hemodynamic Benefit of Contralateral Carotid Endarterectomy in Patients With Symptomatic Internal Carotid Artery Occlusion

Rutgers

Klijn

Kappelle

et al. 2001

Stroke

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Background and Purpose-We sought to investigate whether in patients with a symptomatic internal carotid artery (ICA) occlusion, endarterectomy of a severe stenosis of the contralateral carotid artery can establish long-term cerebral hemodynamic improvement. Methods-Nineteen patients were studied on average 1 month before and 6 months after contralateral carotid endarterectomy (CEA). Volume flow in the main extracranial and intracranial arteries was measured with MR angiography. Collateral flow via the circle of Willis and the ophthalmic arteries was studied with MR angiography and transcranial Doppler sonography, respectively. Cerebral metabolism and CO 2 vasoreactivity were investigated with MR spectroscopy and transcranial Doppler sonography, respectively. Twelve nonoperated patients with a symptomatic ICA occlusion and contralateral ICA stenosis, who were matched for age and sex, served as control patients. Results-In patients who underwent surgery, flow in the operated ICA increased significantly (PϽ0.05) and flow in the basilar artery decreased significantly (PϽ0.01) after CEA. On the occlusion side, mean flow in the middle cerebral artery increased significantly from 71 to 85 mL/min (PϽ0.05) after CEA. The prevalence of collateral flow via the anterior communicating artery to the occlusion side increased significantly (47% before and 84% after CEA; PϽ0.05), while the prevalence of reversed ophthalmic artery flow on the operation side decreased significantly (42% before and 5% after CEA; PϽ0.05). In the hemisphere on the side of the ICA occlusion, lactate was no longer detected after CEA in 80% of operated patients, whereas it was no longer detected over time in 14% of nonoperated patients (PϽ0.05). CO 2 reactivity increased significantly in operated patients in both hemispheres (PϽ0.01). Conclusions-Contralateral

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“…21 Patient age, impaired cerebrovascular reactivity, measured preoperatively by assessing acetazolamide or breath holding, induced changes in cerebral blood flow, asymmetry index, and preoperative CBF reduction have also been suggested as significant predictors of hyperperfusion syndrome after CAS or CEA. 21,26,[53][54][55][56] Diseases that can result in microangiopathy affecting endothelium of small vessels (ie, diabetes mellitus or longstanding pre-existing hypertension) have been found to predispose to hyperfusion and CHS development. 2,57 The use of anticoagulants and antiplatelet agents is routine after CAS as well as after surgery.…”

Section: Risk Factors and Prediction Of Hyperperfusion And Cerebral Hmentioning

confidence: 99%

Hyperperfusion syndrome after carotid revascularization

Moulakakis

Mylonas

Sfyroeras

et al. 2009

Journal of Vascular Surgery

229

166

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Cerebral hyperperfusion syndrome is a rare, serious complication of carotid revascularization either after carotid endarterectomy or carotid stent placement. Impaired cerebral autoregulation and post-revascularization changes in cerebral hemodynamics are the main mechanisms involved in the development of the syndrome. Hyperperfusion syndrome may be fatal once an intracranial hemorrhage occurs. This article reviews the literature, intending to make a synthesis of all new data concerning the clinical manifestations of hyperperfusion syndrome, the pathophysiologic pathways involved in its development, the prediction, and the appropriate management. Also, a review of the most recent series of hyperperfusion syndrome following carotid revascularization, both with classic open endarterectomy and carotid artery stenting has been performed.

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Cerebrovascular reactivity before and after carotid endarterectomy

Cited by 13 publications

References 23 publications

Hemodynamic and Metabolic Changes After Carotid Endarterectomy in Patients With High-Degree Carotid Artery Stenosis

Hemodynamic and Metabolic Changes After Carotid Endarterectomy in Patients With High-Degree Carotid Artery Stenosis

Sustained Bilateral Hemodynamic Benefit of Contralateral Carotid Endarterectomy in Patients With Symptomatic Internal Carotid Artery Occlusion

Hyperperfusion syndrome after carotid revascularization

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