Ultrasonografic monitoring of hemodynamic parameters in symptomatic and asymptomatic patients with high-grade carotid stenosis prior and following carotid endarterectomy

Mitrasinovic, Anka; Kolár, J; Radak, Sandra; Nenezić, Dragoslav; Kuprešanin, Ivana; Aleksić, Nikola; Babić, Srdjan; Tanasković, Slobodan; Mitrašinović, Dejan; Radak, Djordje

doi:10.2298/vsp1205399m

Cited by 3 publications

(2 citation statements)

References 21 publications

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“…In the series conducted by Ogasawara et al 11 , 16.7%-28.6% of the patients with an increase in CBF 100% developed CHS. Also, in some cases with slightly elevated CBF, CHS can be developed 11,12 . That leads to the conclusion that other factors play a role in the occurrence of CHS.…”

Section: Pathophysiologymentioning

confidence: 99%

“…Although this most commonly appears after CAS and CEA, CHS was described and after the subclavian artery stenting 20 and after the endovascular reconstruction of carotid artery in a high-flow carotid-jugular fistula 21 . The reported incidence rate of CHS and ICH after CEA is 1.9% and 0.37% and 1.16% and 0.74% after CAS 3,6,7,[10][11][12]22 . The most common symptoms include: headaches, fluctuation of consciousness, confusion and focal neurologic deficit (Table 1).…”

Section: Clinical Presentation Risk Factors and Diagnosticsmentioning

confidence: 99%

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How to identify risk for cerebral hyperperfusion syndrome after carotid revascularization procedures

2019

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Section: Pathophysiologymentioning

confidence: 99%

Section: Clinical Presentation Risk Factors and Diagnosticsmentioning

confidence: 99%

How to identify risk for cerebral hyperperfusion syndrome after carotid revascularization procedures

2019

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Understanding perioperative risk determinants in carotid endarterectomy: the impact of compromised circle of Willis morphology on inter-hemispheric blood flow indices based on intraoperative internal carotid artery stump pulse pressure and backflow patterns

Czinege,

Sándor,

Gyürki

et al. 2024

GeroScience

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Carotid artery stenosis (CAS) often requires surgical intervention through carotid endarterectomy (CEA) to prevent stroke. Accurate cerebrovascular risk assessments are crucial in CEA, as poor collateral circulation can lead to insufficient interhemispheric blood flow compensation, resulting in ischemic complications. Therefore, understanding perioperative risk determinants is vital. This study aims to determine the impact of compromised circle of Willis (CoW) morphology on inter-hemispheric blood flow, focusing on indices based on intraoperative internal carotid artery stump pulse pressure and backflow patterns. In 80 CAS patients who underwent CEA, preoperative CT angiography for CoW was conducted. Patients were categorized into five subgroups based on their CoW anatomy and three additional groups based on intraoperative internal carotid artery (ICA) stump backflow patterns evaluated by the surgeon. Continuous blood pressure signals, including systolic, diastolic, mean, and pulse pressure values, were recorded during the procedure. The relationship between CoW anatomical variants and the systolic and diastolic segments of the averaged pressure waveforms, particularly diastolic pressure decay, was analyzed. The correlation between CoW anatomy and stump backflow intensity was also examined. Significant variability in ICA stump backflow and pressure values was evident across CoW variants. Patients with compromised CoW morphology exhibited weaker backflow patterns and lower ICA stump pulse pressure values, consistent with impaired interhemispheric blood flow. Notably, ICA stump diastolic pressure decay was consistent across most CoW variant groups, indicating developed collateral circulation in cases with CoW anomalies. Thus, impaired CoW integrity is associated with compromised interhemispheric blood flow indices based on intraoperative ICA stump pulse pressure and backflow patterns during CEA. Integrating intraoperative pulse waveform analysis with preoperative CT angiography provides a more detailed assessment of cerebrovascular risk, guiding the selective use of shunts. This combined approach may improve surgical outcomes and patient safety by identifying patients at increased risk of perioperative neurological events due to CoW anomalies.

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Multi-mode CT in the evaluation of leptomeningeal collateral flow and the related factors: comparing with digital subtraction angiography

Liu

Pan

et al. 2016

Neurological Research

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Ultrasonografic monitoring of hemodynamic parameters in symptomatic and asymptomatic patients with high-grade carotid stenosis prior and following carotid endarterectomy

Abstract: The occlusion of the contralateral ICA is an important factor differentiating between symptomatic and asymptomatic patients with severe carotid stenosis. Successful surgery provides good recovery of cerebral hemodynamics in both symtomatic and asymptomatic patients.

Cited by 3 publications

References 21 publications

How to identify risk for cerebral hyperperfusion syndrome after carotid revascularization procedures

How to identify risk for cerebral hyperperfusion syndrome after carotid revascularization procedures

Understanding perioperative risk determinants in carotid endarterectomy: the impact of compromised circle of Willis morphology on inter-hemispheric blood flow indices based on intraoperative internal carotid artery stump pulse pressure and backflow patterns

Multi-mode CT in the evaluation of leptomeningeal collateral flow and the related factors: comparing with digital subtraction angiography

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