title: Two-Stage Cerebral Hemodynamic Changes in Staged Carotid Angioplasty and Stenting.
abstract: OBJECTIVE
  We sought to assess the different patterns of cerebral hemodynamic changes in staged carotid angioplasty and stenting (CAS).
  
  
  METHODS
  We prospectively recruited a cohort of patients with regular angioplasty or staged angioplasty from October 2013 to August 2015. The hemodynamic changes, including peak systolic, end-diastolic, and mean flow velocities in the ipsilateral middle cerebral artery (MCA) and the contralateral anterior cerebral artery (ACA), were recorded by transcranial Doppler ultrasound.
  
  
  RESULTS
  Between October 2013 to August 2015, 25 patients (age range from 48 to 78 years, 96% male) with CAS were recruited, of whom 13 patients received staged angioplasty and 12 patients received regular angioplasty. Patients in the staged angioplasty group showed a higher degree of stenosis in the internal carotid artery. After the procedure, the peak systolic, diastolic, and mean flow velocities in the ipsilateral MCA in the staged angioplasty group were significantly higher than those in the regular angioplasty group (P = .028, .036, and .027, respectively). In the staged angioplasty group, first, the peak systolic, end-diastolic, and mean flow velocities in the contralateral ACA decreased significantly soon after balloon dilation in stage I (P = .042, .033, and .034, respectively). Second, the peak systolic, diastolic, and mean flow velocities in the ipsilateral MCA increased after stent placement in stage II (P = .006, .042, and .003, respectively).
  
  
  CONCLUSIONS
  Two-stage hemodynamic changes were observed in staged angioplasty. The velocities in the ipsilateral MCA started to increase significantly after the collateral flow diminished.
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Fei
authors.initials: F
authors.lastname: Wu
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Lei
authors.initials: L
authors.lastname: Huang
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Gang
authors.initials: G
authors.lastname: Lu
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Liang
authors.initials: L
authors.lastname: Ge
authors.affiliation: Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China.
authors.forename: Xiaolong
authors.initials: X
authors.lastname: Zhang
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China. Electronic address: wenjiecao@fudan.edu.cn.
authors.forename: Wenjie
authors.initials: W
authors.lastname: Cao
authors.affiliation: Department of Neurology, Huashan Hospital, Fudan University, Shanghai, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China. Electronic address: qiang_dong163@163.com.
authors.forename: Qiang
authors.initials: Q
authors.lastname: Dong
mesh_terms: D000368:Aged; D015901:Angiography, Digital Subtraction; D017130:Angioplasty / Q000295:instrumentation*; D020771:Anterior Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D001783:Blood Flow Velocity; D002343:Carotid Artery, Internal / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology / Q000628:therapy*; D002560:Cerebrovascular Circulation; D003097:Collateral Circulation; D005260:Female; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology*; D011446:Prospective Studies; D012720:Severity of Illness Index; D015607:Stents; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
keywords: Doppler; Ultrasonography; angioplasty; carotid stenosis; stents; transcranial