Evaluation of cerebral blood flow by transcranial Doppler after carotid artery stenting

Abstract BACKGROUND: Cerebral hyperperfusion syndrome sometimes occurs after carotid revascularization in patients with severe hemodynamic failure. To prevent cerebral hyperperfusion syndrome, cerebral hyperperfusion phenomenon (CHP) must be detected early. Single-photon emission computed tomography (SPECT) is useful for detecting CHP, but it is impractical on a daily basis. A tool with high availability to find CHP is desired. OBJECTIVE: To investigate whether global oxygen extraction fraction (OEF) by a blood sampling method is useful for indicating CHP after carotid artery stenting (CAS). METHODS: When patients underwent elective CAS from September 2010 to August 2012, we performed blood sampling for OEF calculation and SPECT before and immediately after elective CAS. Data were collected prospectively. OEF was calculated from the cerebral arteriovenous oxygen difference. Cerebral blood flow was measured in the affected middle cerebral artery (MCA) territory and in the ipsilateral cerebellum by SPECT. The ratio of MCA to cerebellar activity was defined as cerebral blood flow in the affected MCA territory divided by cerebral blood flow in the ipsilateral cerebellar hemisphere. Probable CHP was defined as ≥10% increase in the ratio of MCA to cerebellar activity after CAS. The relationship between peri-CAS OEF and probable CHP was evaluated. RESULTS: Of the 96 patients enrolled, 92 patients were analyzed. Probable CHP occurred in 17 patients. Post-CAS OEF was related to probable CHP (P < .01), but pre-CAS OEF was not. The receiver-operating characteristic curve showed that the cutoff value was 45% for probable CHP (P < .001). CONCLUSION: An increase in blood sampling OEF immediately after CAS was related to probable CHP; then the oxygen demand should be reduced.

Download Full-text

Predicting Hemodynamic Changes of Cerebral Blood Flow during Temporal Carotid Occlusion: A Review of Current Knowledge with Implication for Carotid Artery Stenting

International Journal of Angiology ◽

10.1055/s-0035-1555132 ◽

2015 ◽

Vol 24 (03) ◽

pp. 210-214 ◽

Cited By ~ 1

Author(s):

Cyril Stechovsky ◽

Martin Horvath ◽

Petr Hajek ◽

Josef Veselka ◽

Miloslav Spacek

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Current Knowledge ◽

Carotid Occlusion ◽

Hemodynamic Changes

Download Full-text

New-onset lesions on MRI-DWI and cerebral blood flow changes on 3D-pCASL after carotid artery stenting

Scientific Reports ◽

10.1038/s41598-021-87339-z ◽

2021 ◽

Vol 11 (1) ◽

Author(s):

Wen-Xin Wang ◽

Ting Wang ◽

Lin Ma ◽

Zheng-Hui Sun ◽

Ge-Sheng Wang ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Carotid Artery Stenting ◽

Three Dimensional ◽

Diffusion Weighted Images ◽

Parietal Lobes ◽

Before And After ◽

Continuous Arterial Spin Labeling ◽

New Onset

AbstractThis study aimed to investigate the relationship between the new-onset hyperintense lesions on diffusion-weighted images (DWI) and the changes of cerebral blood flow (CBF) before and after carotid artery stenting (CAS) in patients with symptomatic unilateral carotid artery stenosis. Twenty-four patients with symptomatic unilateral carotid stenosis (50–99%) were enrolled. Routine head magnetic resonance imaging and three-dimensional pseudo-continuous arterial spin labeling were taken 7 days before the surgery and for four consecutive days post CAS. While the incidence of new DWI lesions were high (17/24, 70.8%) and 176 lesions were observed among the 17 cases, there was only one subject showing the symptoms. The majority of the lesions were located at the cortex/subcortex of the ipsilateral frontal and parietal lobes (60.8%) with 92.6% of the lesions size being less than 3 mm. The CBFs in this area were significantly higher than that of the temporal lobe on the first 3 days post stenting (p < 0.05). No periprocedural CBF differences were observed between the two groups, however, the micro-embolism group presented decreased relative CBF in frontal and parietal lobes prior to stenting compared with the non-embolism group. The systolic blood pressure in the micro-embolism group at discharge was significantly lower than that at admission. The high incidence rate of micro-embolism in patients receiving CAS may not be the result of direct changes of hemodynamics in the brain but rather the loss of CBF regulation due to long-term hypoperfusion prior to the stenting.

Download Full-text

Isolated Intraventricular Hemorrhage after Carotid Artery Stenting

Journal of the Korean Neurological Association ◽

10.17340/jkna.2021.3.13 ◽

2021 ◽

Vol 39 (3) ◽

pp. 188-191

Author(s):

Jiyong Shin ◽

Jihee Ko ◽

Minju Kim ◽

Chul-Hoo Kang ◽

Jay Chol Choi ◽

...

Keyword(s):

Blood Pressure ◽

Blood Flow ◽

Cerebral Blood Flow ◽

Carotid Artery ◽

Pressure Fluctuation ◽

Carotid Artery Stenting ◽

Intraventricular Hemorrhage ◽

Rare Complication ◽

Hyperperfusion Syndrome ◽

Blood Pressure Fluctuation

Cerebral intraventricular hemorrhage (IVH) is an extremely rare complication of carotid artery stenting (CAS). Fully dilated terminal arteries of a chronic, severely stenosed proximal artery could be ruptured by impaired autoregulation of cerebral blood flow. Hyperperfusion syndrome can occur even if there is no blood pressure fluctuation during the CAS. We report a case of an isolated IVH that occurred hours after CAS.

Download Full-text