Influence of poststenotic collateral pressure on blood flow velocities within high-grade carotid artery stenosis: Differences between morphologic and functional measurements

Abstract Balance and mobility function worsen with age, and more so for those with underlying diseases. Our research has demonstrated that asymptomatic carotid artery stenosis (ACAS) is associated with worse balance and mobility, and a higher fall risk, compared to older adults with similar comorbidities, but without ACAS. Thus, ACAS, with attendant blood flow-restriction to the brain is a potentially modifiable risk factor for balance and mobility dysfunction. The purpose of this study was to evaluate the impact of restoring blood flow to the brain by carotid revascularization, on balance and mobility in patients with high-grade ACAS (≥70% diameter-reducing stenosis). Twenty adults (67.0±9.4 years) undergoing carotid revascularization for high-grade stenosis were enrolled. A balance and mobility assessment was performed before- and six weeks- after carotid revascularization and included: Short Physical Performance Battery (SPPB), Berg Balance Scale (BBS), Four Square Step Test (FSST), Dynamic Gait Index (DGI) Timed Up and Go (TUG), gait speed, MiniBESTest, and Walk While Talk (WWT) test. Paired t-tests assessed changes in outcome measures between the two-time points. Significant improvements were observed in measures that combined walking with dynamic movements, DGI (P=0.003), and MiniBESTest (P=0.021). Pearson’s correlations examined the relationship between balance and mobility before surgery and change score after surgery. Patients with lower baseline DGI and MiniBest scores demonstrated the most improvement on follow-up testing (r=-0.70, p=0.001, and r=-0.59, p=0.006, respectively). In conclusion, revascularization of a carotid artery stenosis improves balance and mobility; the greatest improvements are observed in those patients that are the most impaired.

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Cerebral blood flow reserve assessment in symptomatic versus asymptomatic high-grade internal carotid artery stenosis.

Stroke ◽

10.1161/01.str.25.5.1010 ◽

1994 ◽

Vol 25 (5) ◽

pp. 1010-1013 ◽

Cited By ~ 21

Author(s):

N Nighoghossian ◽

P Trouillas ◽

B Philippon ◽

R Itti ◽

P Adeleine

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Internal Carotid Artery ◽

Carotid Artery Stenosis ◽

Internal Carotid ◽

Internal Carotid Artery Stenosis ◽

Artery Stenosis ◽

High Grade ◽

Flow Reserve

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Intracranial Blood Flow Changes in Patients with High-Grade Severe Carotid Artery Stenosis After Stenting

World Neurosurgery ◽

10.1016/j.wneu.2017.04.144 ◽

2017 ◽

Vol 104 ◽

pp. 863-868 ◽

Cited By ~ 1

Author(s):

Lei Huang ◽

Wenjie Cao ◽

Liang Ge ◽

Gang Lu ◽

Xiaolong Zhang ◽

...

Keyword(s):

Blood Flow ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Artery Stenosis ◽

High Grade ◽

Flow Changes

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Cerebral blood flow and cerebrovascular reactivity capacity in patients with bilateral high-grade carotid artery stenosis

Acta Neurologica Scandinavica ◽

10.1111/j.1600-0404.1996.tb00559.x ◽

1996 ◽

Vol 93 ◽

pp. 90-92 ◽

Cited By ~ 2

Author(s):

Hon-Man Liu ◽

Yong-Kwang Tu ◽

Ping-Keung Yip ◽

Cheng-Tau Su

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Cerebrovascular Reactivity ◽

Artery Stenosis ◽

High Grade

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Association between Pre-Existing Coronary Artery Disease and 5-Year Mortality in Stroke Patients with High-Grade Carotid Artery Stenosis

European Neurology ◽

10.1159/000512407 ◽

2020 ◽

pp. 1-7

Author(s):

Ching-I Wu ◽

Chia-Lun Wu ◽

Feng-Chieh Su ◽

Shun-Wen Lin ◽

Wen-Yi Huang

Keyword(s):

Coronary Artery Disease ◽

Coronary Artery ◽

Carotid Artery ◽

Carotid Artery Stenosis ◽

Significant Risk ◽

Cox Proportional Hazards Model ◽

Artery Stenosis ◽

High Grade ◽

Increased Risk ◽

Artery Disease

Background: The coincidence of coronary artery disease (CAD) and carotid artery stenosis (CAS) was observed. However, the association between pre-existing CAD and ischemic stroke (IS) outcome in patients with high-grade CAS remains unclear. We aimed to investigate the association between pre-existing CAD and outcomes of acute IS patients with high-grade CAS. Methods: From January 1, 2007, to April 30, 2012, we enrolled 372 acute IS patients with high-grade CAS and prospectively observed them for 5 years. Demographic features, vascular risk factors, comorbidities, and outcomes were compared between patients with and without pre-existing CAD. Results: Among 372 individuals, 75 (20.2%) patients had pre-existing CAD and 297 (79.8%) patients did not have pre-existing CAD. The prevalence rates of hypertension, congestive heart failure, chronic kidney disease, and gout in patients with pre-existing CAD were significantly higher than in those without pre-existing CAD (p = 0.017, p < 0.001, p = 0.002, and p < 0.001, respectively). The multivariate Cox proportional hazards model revealed that pre-existing CAD was a significant risk factor for a 5-year all-cause mortality in acute IS patients with high-grade CAS (hazard ratio = 2.26; 95% confidence interval = 1.35–3.79; p = 0.002). Conclusion: Pre-existing CAD was associated with an increased risk of 5-year mortality in acute IS patients with high-grade CAS. Intensive treatment for the pre-existing CAD may reduce long-term mortality in acute IS patients with high-grade CAS.

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Diagnostic dilemmas of multislice CT angiography in the evaluation of the degree of common carotid artery stenosis

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1008494n ◽

2010 ◽

Vol 138 (7-8) ◽

pp. 494-497

Author(s):

Dragoslav Nenezic ◽

Slobodan Tanaskovic ◽

Predrag Gajin ◽

Nenad Ilijevski ◽

Goran Vucurevic

Keyword(s):

Carotid Artery ◽

Ct Angiography ◽

Common Carotid Artery ◽

Carotid Artery Stenosis ◽

Soft Tissues ◽

Multislice Ct ◽

Diagnostic Procedures ◽

Left Common Carotid Artery ◽

Artery Stenosis ◽

High Grade

Introduction. Multislice CT angiography (CTA) is a noninvasive and quick technique to image carotid artery stenosis, as well as intracerebral vasculature. Modern multidetector CTA produces images with a high resolution of, not only the contrast-filled lumen, but also of the vessel wall and the surrounding soft tissues. Multiple studies have verified the ability of CTA to provide an accurate representation of the degree of carotid stenosis in comparison to digital subtraction angiography, both for moderate and high-grade stenosis. Because of its fast and accurate vessel imaging, CT angiography is increasingly used in the assessment of carotid artery stenosis. Case Outline. A 37-year-old female patient was admitted at the Vascular Surgery Clinic of the Institute for Cardiovascular Diseases 'Dedinje', Belgrade, for angiography and endovascular procedure of a high-grade stenosis of the left common carotid artery based on Multislice CT findings brought by the patient. She complained of problems which we considered to be the result of cerebral circulation ischemia. After detailed diagnostic procedures, we concluded that no pathological lesions could be verified either on the left common carotid artery or other supraaortic branches. Therefore, the patient was discharged for further neurological examinations. Conclusion. Although Multislice CTA has many advantages over classical angiography, its validity should be taken with reserve, especially in younger patients.

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