title: Predicting Hemodynamic Changes of Cerebral Blood Flow during Temporal Carotid Occlusion: A Review of Current Knowledge with Implication for Carotid Artery Stenting.
abstract: Carotid artery disease (CAD) plays an important role in the stroke development and its prevalence increases with aging of the population. Its wide variability of clinical manifestation ranges from incidental asymptomatic finding to devastating or fatal stroke, although cerebral collateral circulation is considered one of the major modifying factors. Over time, carotid artery stenting (CAS) has evolved into a reputable method for the treatment of patients with severe CAD. With expanding use of proximal protection systems resembling surgical clamp, there is an increasing demand to understand collateral cerebral circulation to protect patients from periprocedural hypoperfusion, which increases the risk of cerebral events. Transcranial Doppler ultrasound (TCD) is a useful tool allowing monitoring in real time during procedure patient́s cerebral hemodynamic status providing the operator with valuable information. Its role in predicting periprocedural hypoperfusion is, however, less well established. In this article, we discuss the role of cerebral collateral circulation, summarize the current knowledge regarding its evaluation with TCD and suggest future implications for CAS.
authors.affiliation: Department of Cardiology, Motol University Hospital, 2nd Medical School, Charles University, V Úvalu, Prague, Czech Republic.
authors.forename: Miloslav
authors.initials: M
authors.lastname: Spacek
authors.affiliation: Department of Cardiology, Motol University Hospital, 2nd Medical School, Charles University, V Úvalu, Prague, Czech Republic.
authors.forename: Cyril
authors.initials: C
authors.lastname: Stechovsky
authors.affiliation: Department of Cardiology, Motol University Hospital, 2nd Medical School, Charles University, V Úvalu, Prague, Czech Republic.
authors.forename: Martin
authors.initials: M
authors.lastname: Horvath
authors.affiliation: Department of Cardiology, Motol University Hospital, 2nd Medical School, Charles University, V Úvalu, Prague, Czech Republic.
authors.forename: Petr
authors.initials: P
authors.lastname: Hajek
authors.affiliation: Department of Cardiology, Motol University Hospital, 2nd Medical School, Charles University, V Úvalu, Prague, Czech Republic.
authors.forename: Josef
authors.initials: J
authors.lastname: Veselka
keywords: carotid endarterectomy; carotid occlusion; carotid stenting; cerebral collateral circulation; cerebrovascular reserve; transcranial Doppler