title: Cerebral hemodynamics and baroreflex sensitivity after carotid artery stenting.
abstract: OBJECTIVE
  The long-term hemodynamic effects of carotid angioplasty and stenting (CAS) are unclear. We performed a longitudinal study to investigate the variations in cerebral hemodynamics in patients undergoing CAS.
  
  
  METHODS
  We performed prospective evaluation of 63 symptomatic male patients (19 patients had transient ischemic attack and 44 had minor stroke; mean age: 77.3 ± 6.3 years [range: 51-86]). The mean blood flow velocities (MBFV) and pulsatility index (PI) of the middle cerebral arteries (MCA) on both sides were evaluated using transcranial color-coded Doppler (TCCD) ultrasonography. Cardiac autonomic activities were evaluated by measuring baroreflex sensitivity (BRS). All parameters were measured at baseline prior to CAS and at 1, 3, 6, and 12 months after CAS.
  
  
  RESULTS
  The preoperative MBFV and PI of the ipsilateral MCA were significantly lower than those of the contralateral side. However, after CAS, MBFV in the ipsilateral MCA increased significantly until 2 weeks after stenting, after which the MBFV gradually decreased and remained stable for 1 year after CAS. Further, we observed a nonsignificant increase in MBFV in the contralateral MCA after CAS. In contrast to the MBFV, the BRS values decreased significantly 1 month after stenting and returned to baseline levels 6 months after CAS.
  
  
  CONCLUSIONS
  Patients with CAS showed improved global cerebral hemodynamic status. However, the BRS did not normalize initially, and baseline value was achieved at 6 months after stenting.
authors.affiliation: Department of Neurology, Taipei Veterans General Hospital, Taiwan.
authors.forename: L-C
authors.initials: LC
authors.lastname: Hsu
authors.forename: F-C
authors.initials: FC
authors.lastname: Chang
authors.forename: T B J
authors.initials: TB
authors.lastname: Kuo
authors.forename: W-J
authors.initials: WJ
authors.lastname: Wong
authors.forename: H-H
authors.initials: HH
authors.lastname: Hu
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D017704:Baroreflex / Q000502:physiology*; D001783:Blood Flow Velocity; D016893:Carotid Stenosis / Q000473:pathology* / Q000503:physiopathology*; D002533:Cerebral Angiography; D002540:Cerebral Cortex / Q000098:blood supply*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging; D011446:Prospective Studies; D015607:Stents; D020521:Stroke / Q000601:surgery; D013624:Taiwan; D013997:Time Factors; D017585:Ultrasonography, Doppler, Transcranial