TCD evaluation before and after stenting in patients with severe primary carotid artery stenosis versus restenosis.
OBJECTIVE
To evaluate cerebral hemodynamics before and after carotid angioplasty and stenting (CAS) using transcranial Doppler (TCD).


METHODS
Sixty-eight patients (52 men; mean age 69+/-9.5 years) with severe carotid stenosis (83.4%+/-10.2%) were examined by TCD before and 2 months after CAS. Thirty-two (47%) patients had primary carotid stenosis and 36 (53%) had restenosis after carotid endarterectomy (CEA). A broad TCD protocol was employed to estimate cerebral hemodynamics, including assessment of velocities (V) and asymmetry of cerebral blood flow velocity (CBFV) in the middle cerebral artery, (MCA) anterior cerebral artery (ACA), and basilar artery (BA); the pulsatility indexes; and flow acceleration.


RESULTS
Ipsilateral MCA mean velocities before stenting were 46.3+/-12.6 cm/s in the primary stenosis group and 47.1+/-12.3 cm/s in restenosis group; after stenting, the velocities were 53.8+/-12.1 and 52.7+/-9.6 cm/s, respectively (p<0.005 for both groups). MCA asymmetry by Vmean before CAS was higher in the primary stenosis group (27.6%+/-2.4% versus 19.8%+/-2.3%, p<0.05). After stenting, this index was significantly lower in both groups: 16.4%+/-2.4% and 12.3%+/-2.3%, respectively (p<0.0001 for each group). All other TCD parameters improved significantly in both groups after CAS as well (p<0.05), showing the strong hemodynamic effect of this procedure.


CONCLUSIONS
CAS effectively improves cerebral hemodynamics in patients with severe primary and restenosis of the internal carotid artery.
Telman
Gregory
G
Department of Neurology, Rambam Health Care Campus, Haifa, Israel. g_telman@rambam.health.gov.il
Kouperberg
Efim
E
Sprecher
Elliot
E
Gruberg
Luis
L
Beyar
Rafael
R
Yarnitsky
David
D
D000368:Aged; D000800:Angioplasty, Balloon; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D001488:Basilar Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D001783:Blood Flow Velocity; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery / Q000628:therapy; D002560:Cerebrovascular Circulation; D016894:Endarterectomy, Carotid / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D011673:Pulsatile Flow; D012008:Recurrence; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial