Effect of internal carotid artery occlusion on intracranial hemodynamics. Transcranial Doppler evaluation and clinical correlation.

Schneider, Peter A.; Rossman, M E; Bernstein, Eugene F.; Torem, Shlomo; Ringelstein, E. B.; Otis, Shirley M.

doi:10.1161/01.str.19.5.589

Cited by 109 publications

(57 citation statements)

References 22 publications

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“…The preoperative difference in PI between asymptomatic and symptomatic CO groups is in accord with previous findings (Schneider et al, 1988). We also confirm the increase of PI after CEA on the operated side.…”

Section: Discussionsupporting

confidence: 92%

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Baracchini

Meneghetti

Manara

et al. 2006

J Cereb Blood Flow Metab

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We sought to investigate whether carotid endarterectomy (CEA) can achieve long-term cerebral hemodynamic improvement and reduce recurrence of cerebral ischemic events in symptomatic and asymptomatic patients with severe ( > 70%) carotid artery stenosis contralateral to carotid occlusion (CO). Thirty-nine patients with severe carotid lesion contralateral to CO were studied before (1 day) and after CEA (at 7 days, 1, 3 and 6 months, and then yearly thereafter). Collateral flow and cerebral vasomotor reactivity (VMR) were assessed by transcranial Doppler sonography (TCD). A total of 32 unoperated patients with severe carotid lesion contralateral to CO, who were comparable with respect to age and sex, served as a control group. The average period of TCD follow-up was 10 years and was obtained in all patients; during this period, major clinical events (stroke, acute myocardial infarction and death) were also recorded. The proportion of patients with collateral flow via the anterior communicating artery increased significantly from 61.5% before to 89.7% after CEA (P = 0.01). Cerebral VMR ipsilateral to CO improved in 85.7% of patients (30 of 35) within 30 days of CEA, and in all patients within 90 days. No significant spontaneous VMR recovery was recorded in the control group. After the initial recovery, no significant change in VMR was observed in the surgical group or the control group during the follow-up. In conclusion, in patients with severe carotid stenosis, CEA contralateral to symptomatic and asymptomatic CO determines a durable cerebral hemodynamic improvement not only on the side of the CEA but also on the contralateral side, with no difference between symptomatic and asymptomatic patients.

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Section: Discussionsupporting

confidence: 92%

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Baracchini

Meneghetti

Manara

et al. 2006

J Cereb Blood Flow Metab

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“…Increase of PI after CEA has been confirmed previously. 36 The preoperative difference in PI between asymptomatic and symptomatic CS groups is in accord with previous findings, 35 and the greater improvement of pulsatility in symptomatic CS supports the notion of a more severe initial hemodynamic impairment. As well, the correlation between the improvement in interhemispheric asymmetry of MR parameters and BHI underscores the effect of CEA in the symptomatic CS group.…”

Section: Discussionsupporting

confidence: 84%

“…28 It has been associated with symptomatic status, but its predictive value has been poor. 7,35 CS is known to decrease PI by reducing inflow, and the retained pulsatility is thought to indicate lower impedance of collateral vessels. Increase of PI after CEA has been confirmed previously.…”

Section: Discussionmentioning

confidence: 99%

Cerebral Hemodynamics in Asymptomatic and Symptomatic Patients With High-Grade Carotid Stenosis Undergoing Carotid Endarterectomy

Soinne

Helenius

Tatlısumak

et al. 2003

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Background and Purpose-Asymptomatic patients with carotid stenosis benefit less from carotid endarterectomy (CEA) than symptomatic patients because the risk of embolic events is lower, but it is not known whether the hemodynamic effect of CEA is different between the groups. We evaluated hemodynamics of symptomatic and asymptomatic patient groups before and after CEA. Methods-Forty-six independent patients with a unilateral high-grade carotid stenosis, 23 asymptomatic and 23 symptomatic, underwent dynamic susceptibility contrast MRI (DSC-MRI) and transcranial Doppler ultrasound (TCD) evaluation before CEA and 3 and 100 days afterward. Quantitative perfusion parameters were calculated separately in selected regions of white and gray matter and watershed regions in each hemisphere, and mean transit time (MTT) maps were assessed visually by 2 independent observers. Vasomotor reactivity was determined with breath-holding index and flow impedance with pulsatility index ipsilaterally. Results-In contrast to the asymptomatic carotid stenosis group, symptomatic carotid stenosis patients had preoperatively increased MTT and lower cerebral blood flow values in the ipsilateral hemisphere, more in white matter and watershed regions than in gray matter. Visually detected perfusion deficits were associated with symptomatic status. The interhemispheric asymmetries were abolished by CEA. The improving trend over time was greater in the symptomatic carotid stenosis group and was best seen in MTT. On TCD, pulsatility index was lower in symptomatic carotid stenosis patients preoperatively, with no postoperative difference, whereas the breath-holding index improved only in the symptomatic carotid stenosis group after CEA. Conclusions-Patients

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“…4 -5 . 7 Transorbital Doppler evaluation was performed using the same equipment. With the patient in the same position, the 2-MHz probe was placed over the orbit using coupling gel, with the eyelid closed.…”

mentioning

confidence: 99%

Noninvasive assessment of cerebral collateral blood supply through the ophthalmic artery.

Schneider

Rossman

Bernstein

et al. 1991

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Effect of internal carotid artery occlusion on intracranial hemodynamics. Transcranial Doppler evaluation and clinical correlation.

Cited by 109 publications

References 22 publications

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Cerebral Hemodynamics after Contralateral Carotid Endarterectomy in Patients with Symptomatic and Asymptomatic Carotid Occlusion: A 10-Year Follow-Up

Cerebral Hemodynamics in Asymptomatic and Symptomatic Patients With High-Grade Carotid Stenosis Undergoing Carotid Endarterectomy

Noninvasive assessment of cerebral collateral blood supply through the ophthalmic artery.

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