title: CT measurement of changes in cerebral perfusion in patients with asymptomatic carotid artery stenosis undergoing carotid stenting prior to cardiac surgery: "proof of principle".
abstract: OBJECTIVE
  To identify asymptomatic patients with impaired cerebral perfusion using CT perfusion (CTP) technique during staged carotid stenting (CAS) and cardiac surgery.
  
  
  RESULTS
  This is a prospective, non-randomised study in 16 neurologically asymptomatic patients designed to analyse cerebral perfusion using CTP before and after CAS. Mean transit time (MTT) was significant lower and cerebral blood flow (CBF) was significantly higher in the non-target hemisphere compared to the target hemisphere before treatment (4.64 ± 1.08 s vs. 5.67 ± 1.29 and 57.37 ± 24.90 s vs. 48.19 ± 13.02, respectively). Mean dMTT (absolute difference in MTT values between treated and untreated hemisphere) decreased from 0.92 ± 1.08 s before to 0.04 ± 0.30 s after carotid revascularisation (p<0.05) and mean relative CBF (ratios of the treated to the untreated hemisphere) increased from 0.92 ± 0.12 to 1.04 ± 0.12 after revascularisation (p<0.05). Subgroup analysis based on pre-treatment dMTT showed significant changes in 50% of the patients with larger dMTT. There was one transient ischaemic attack reported 30 days after combined procedure.
  
  
  CONCLUSIONS
  A significant improvement of cerebral perfusion after carotid stenting is shown in about 50% of the asymptomatic patients in this study. This suggests the potential presence of a compromised cerebral circulation in asymptomatic patients with severe carotid artery disease scheduled for cardiac surgery.
authors.affiliation: Department of Interventional Cardiology, St. Antonius Hospital, Nieuwegein, The Netherlands. jvdheijden@antonius.net
authors.forename: Jan
authors.initials: J
authors.lastname: Van der Heyden
authors.forename: Annet
authors.initials: A
authors.lastname: Waaijer
authors.forename: E S
authors.initials: ES
authors.lastname: Van Wouter
authors.forename: Danihel
authors.initials: D
authors.lastname: van Neerven
authors.forename: Uday
authors.initials: U
authors.lastname: Sonker
authors.forename: Maarten J
authors.initials: MJ
authors.lastname: Suttorp
authors.forename: Egbert T
authors.initials: ET
authors.lastname: Bal
authors.forename: Mathias
authors.initials: M
authors.lastname: Prokop
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017130:Angioplasty / Q000009:adverse effects / Q000295:instrumentation*; D058070:Asymptomatic Diseases; D001783:Blood Flow Velocity; D006348:Cardiac Surgical Procedures / Q000009:adverse effects; D016893:Carotid Stenosis / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000601:surgery*; D002560:Cerebrovascular Circulation; D002561:Cerebrovascular Disorders / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D017023:Coronary Angiography; D005260:Female; D006331:Heart Diseases / Q000150:complications / Q000000981:diagnostic imaging / Q000601:surgery*; D006801:Humans; D008297:Male; D009426:Netherlands; D055420:Perfusion Imaging / Q000379:methods*; D011237:Predictive Value of Tests; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D016896:Treatment Outcome; D018616:Ultrasonography, Doppler, Duplex