title: Intraprocedural changes in angiographic cerebral circulation time predict cerebral blood flow after carotid artery stenting.
abstract: Changes in the cerebral blood flow (CBF) are important for planning postoperative care in patients treated by carotid artery stenting (CAS). The relationship between intraprocedural changes in the angiographic cerebral circulation time (CCT) and perioperative CBF changes were retrospectively studied in 49 CAS procedures performed in 46 patients with carotid artery stenosis. The CCT, defined as the interval between the timing of maximal opacification at the terminal portion of the internal carotid artery and at the cortical vein, was determined by referring to time-density curves of data obtained from routine intraprocedural digital subtraction angiography. The intraoperative change in CCT (Delta CCT) was calculated for each of the 49 procedures. CBF studies, using dynamic perfusion computed tomography, were performed 10-2 days before and 2-4 days after CAS. Perioperative changes in the ratio of the CBF in the territory of the middle cerebral artery on the affected side to CBF on the contralateral side (%CBF) were calculated by subtracting pre- from postoperative %CBF (Delta%CBF) and the correlation between Delta CCT and Delta%CBF was evaluated. Mean CCT was shortened by 1.1 seconds from 5.3 to 4.2 seconds after CAS. Mean %CBF increased by 11.9% from 91.8% to 103.7% after the procedure. Delta CCT and Delta%CBF showed a significant positive correlation (r = 0.61, p = 0.008). Intraprocedural changes in angiographic CCT are predictive of postoperative CBF in patients with CAS.
authors.affiliation: Department of Neurosurgery, Fukuoka University Chikushi Hospital, Chikushino, Fukuoka, Japan.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Aikawa
authors.forename: Kiyoshi
authors.initials: K
authors.lastname: Kazekawa
authors.forename: Masanori
authors.initials: M
authors.lastname: Tsutsumi
authors.forename: Masanari
authors.initials: M
authors.lastname: Onizuka
authors.forename: Minoru
authors.initials: M
authors.lastname: Iko
authors.forename: Tomonobu
authors.initials: T
authors.lastname: Kodama
authors.forename: Kouhei
authors.initials: K
authors.lastname: Nii
authors.forename: Shuko
authors.initials: S
authors.lastname: Hamaguchi
authors.forename: Hosei
authors.initials: H
authors.lastname: Etou
authors.forename: Kimiya
authors.initials: K
authors.lastname: Sakamoto
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015901:Angiography, Digital Subtraction / Q000379:methods; D001776:Blood Circulation Time; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D016343:Monitoring, Intraoperative / Q000295:instrumentation; D010347:Patient Care Planning; D055420:Perfusion Imaging; D011182:Postoperative Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D015607:Stents; D016896:Treatment Outcome