scholarly journals Evaluation of Cerebrovascular Reserve Capacity in Symptomatic and Asymptomatic Internal Carotid Stenosis With Transcranial Doppler

2016 ◽  
pp. 917-925 ◽  
Author(s):  
I. DOUVAS ◽  
D. MORIS ◽  
G. KARAOLANIS ◽  
C. BAKOYIANNIS ◽  
S. GEORGOPOULOS
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Transcranial Doppler ◽  
Internal Carotid ◽  
Low Cost ◽  
Reserve Capacity ◽  
Control Group ◽  
Cerebrovascular Reserve ◽  
Cerebrovascular Reserve Capacity ◽  
Asymptomatic Patients

Cerebrovascular reserve capacity (CVRC) is a hemodynamic parameter indicating the brain’s capacity to overcome ischemia. Transcranial Doppler (TCD) is a useful device to measure CVRC, with high availability and low cost. The aim of the study is to investigate asymptomatic patients with affected CVRC, who could benefit from CEA. One hundred and forty five consecutive patients (60 symptomatic and 65 asymptomatic), with internal carotid artery (ICA) stenosis >70 % and 20 healthy individuals without internal carotid stenosis underwent TCD-inhalation CO2 tests in order to measure the CVRC in both hemispheres of each patient. CVRC between asymptomatic and symptomatic patients were significantly different in the 95 % confidence interval (CI) as well as the mean CVRC value in contralateral carotid artery. The correlation between CVRC in the carotid artery with stenosis and the existence of symptoms is significant at the 0.01 level. Additionally, symptoms and CVRC of the contralateral carotid artery are also significant at the 0.05 level and CVRC values in asymptomatic patients and the control group at the 0.01 level. None of the covariant factors, except the age, are significantly correlated with CRVC. CVRC could be an early mark-index to evaluate the risk of stroke in this group of patients and to design their therapeutic approach.

scholarly journals Clinical significance of internal carotid artery restenosis following carotid endarterectomy

2012 ◽  
Vol 140 (7-8) ◽  
pp. 528-532 ◽  
Author(s):  
Djordje Radak ◽  
Slobodan Tanaskovic ◽  
Srdjan Babic ◽  
Nikola Aleksic
Keyword(s):  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Clinical Significance ◽  
Internal Carotid ◽  
Neointimal Hyperplasia ◽  
Carotid Angioplasty ◽  
Atherosclerotic Lesions ◽  
Asymptomatic Patients

Carotid endarterectomy has been established as the preferred treatment for symptomatic and asymptomatic high-grade carotid stenosis. Internal carotid artery restenosis is defined as a specific entity with a great clinical significance in carotid surgery due to accompanied increased future cerebral ischemic events risk. Carotid restenosis is the result of neointimal hyperplasia in the early postoperative period (within 36 months) or recurrent atherosclerotic lesions at a later date. While the restenotic lesions caused by neointimal hyperplasia are determined by ultrasound as smooth lesions, atherosclerotic carotid stenosis has almost the same ultrasound and angiographic characteristics as primary atherosclerotic lesions. Some authors believe that patients with internal carotid artery restenosis have insignificant risk of stroke or progression to total occlusion, and suggest conservative treatment only. On the other hand, many surgeons have more aggressive attitude towards the treatment of asymptomatic carotid stenosis and indicate surgical treatment in asymptomatic patients with carotid restenosis above 80%. The aim of our paper was to present a review of literature available data concerning etiology, pathophysiology, clinical significance and treatment of carotid restenosis following endarterectomy. Numerous studies have reported satisfactory results of redo endarterectomy and carotid angioplasty as treatment options of carotid restenosis. Carotid angioplasty for primary atherosclerotic lesions treatment is accompanied by a high carotid restenosis rate and therefore its role in primary carotid symptomatic and asymptomatic stenosis treatment is still the issue of numerous debates and the subject of extensive ongoing clinical studies worldwide.

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