Preoperative MRA flow quantification in CEA patients: flow differences between patients who develop cerebral ischemia and patients who do not develop cerebral ischemia during cross-clamping of the carotid artery.
OBJECTIVE
We sought to investigate whether preoperative volume flow in the internal carotid arteries (ICAs), the basilar artery (BA), and the middle cerebral arteries (MCAs) and collateral flow via the circle of Willis differ between patients who do and patients who do not develop cerebral ischemia during clamping of the carotid artery in carotid endarterectomy (CEA).


METHODS
Quantitative volume flow in the ICAs, BA, and MCAs and directional flow in the circle of Willis were measured preoperatively with 2-dimensional phase-contrast MR angiography in 86 CEA patients. During the operation, electroencephalographic (EEG) recordings were obtained that were monitored by a clinical neurophysiologist. Reference volume flow values were assessed in 24 control subjects.


RESULTS
In patients with an ICA stenosis without contralateral ICA occlusion (n=62), of whom 16% developed ischemic EEG changes during clamping, preoperative flow in the clamped ICA was significantly higher in patients with cerebral ischemia than in patients without (mean, 278 versus 160 mL/min; P:<0.05). Flow in the contralateral ICA (156 versus 273 mL/min; P:<0.01), flow in the BA (116 versus 165 mL/min; P:<0.05), and presence of collateral flow via the circle of Willis to the clamped ICA (0% versus 37%; P:<0.05) were significantly lower. MCA flow did not differ significantly between groups. Additionally, in patients with an ICA stenosis and a contralateral ICA occlusion (n=24), of whom 42% developed cerebral ischemia, preoperative flow in the clamped ICA was significantly higher in patients with cerebral ischemia than in patients without (309 versus 239 mL/min; P:<0.05). BA flow, MCA flow, and presence of willisian collateral flow (0% versus 14%) did not differ significantly between groups.


CONCLUSIONS
Preoperative volume flow in the clamped ICA is significantly higher in CEA patients with ischemic EEG changes during clamping than in CEA patients without such changes. The latter patients probably have better developed collateral pathways preoperatively.
Rutgers
D R
DR
Department of Radiology, University Medical Center Utrecht (University Hospital Utrecht, Medical Faculty Utrecht, (Netherlands). D.Rutgers@azu.nl
Blankensteijn
J D
JD
van der Grond
J
J
D000368:Aged; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002941:Circle of Willis / Q000000981:diagnostic imaging / Q000503:physiopathology; D003097:Collateral Circulation / Q000502:physiology; D003250:Constriction; D004569:Electroencephalography / Q000706:statistics & numerical data; D016894:Endarterectomy, Carotid / Q000379:methods*; D005260:Female; D006801:Humans; D018810:Magnetic Resonance Angiography / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011859:Radiography; D012039:Regional Blood Flow / Q000502:physiology