Cerebral Hemodynamic Changes after Carotid Angioplasty and Stenting

M.B. Sánchez-Arjona; G. Sanz-Fernández; E. Franco-Macías; A. Gil-Peralta

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Table 1:

Patient demographic data, type of ischemia previous CAS and collateral pathways

Finding	No. of Patients (%)
Sex
Male	52 (80.0)
Female	8 (10.0)
Vascular risk factors and vascular disease
Hypertension	47 (78.3)
Diabetes mellitus	28 (46.7)
Hyperlipemia	41 (68.3)
Smoke	26 (43.3)
Ischemic cardiopathy	16 (26.7)
Peripheral arterial disease	17 (28.3)
Type of ischemia before CAS
Transient ischemic attack (including amaurosis fugax)	33 (55.0)
Minor stroke	15 (25,0)
Major stroke (ranking ≥2)	11 (18.3)
Asymptomatic	6 (10.0)
Concomitant vasculopathy
Contralateral ICA stenosis	35 (58.3)
Contralateral ICA occlusion	10 (16.7)
Vertebral artery stenosis	10 (16.7)
Collateral pathways
Ophthalmic	14 (23.3)
Anterior crossflow	48 (80.0)
Posterior	33 (55.9)
Leptomeningeal	4 (6.7)

Note:—CAS indicates carotid angioplasty stent placement; ICA, internal carotid artery.

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Table 2:

Hemodynamic data immediately after CAS compared with pre-CAS values

Doppler Values	Ipsilateral		Contralateral
Doppler Values	Pre-CAS	Post-CAS	Pre-CAS	Post-CAS
MCA-MFV	49.7 ± 16.8	62.5 ± 22.3^**	51.3 ± 16.9	53.4 ± 16.6
MCA-PI	0.85 ± 0.18	1.09 ± 0.20^**	0.99 ± 0.22	1.03 ± 0.22
ACA-MFV	50.7 ± 21.8	58.9 ± 23.0^*	63.7 ± 22.7	50.3 ± 18.3^**
ACA-PI	0.90 ± 0.22	1.08 ± 0.22^**	0.96 ± 0.27	1.04 ± 0.23^*
PCA-MFV	47.5 ± 21.0	36.5 ± 13.2^**	45.3 ± 15.3	38.6 ± 17.3^**
PCA-PI	1.01 ± 0.22	1.01 ± 0.21	1.00 ± 0.23	1.04 ± 0.22

Note:—CAS indicates carotid angioplasty stent placement; MCA, middle cerebral artery; MFV, mean flow velocity, cm/s; PI, pulsatility index; ACA, anterior cerebral artery; PCA, posterior cerebral artery.
* P ≤ .05.
** P < .01.

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Table 3:

Pre-CAS data compared with post-CAS data 30 days later and P values; early post-CAS data compared with post-CAS data, at 30 days and P value (statistical significance)

Doppler values	Pre-CAS	Early Post-CAS	Post-CAS, at 30 days
iMCA-MFV	50.3 ± 17.0	63.0 ± 21.7	52.8 ± 15.6^**
iMCA-PI	0.84 ± 0.19^**	1.02 ± 0.22	1.12 ± 0.23^**
iCVR	26.0 ± 17.3^**		37.0 ± 22.0
cMCA-MFV	51.5 ± 17.4	54.1 ± 16.9	49.6 ± 16.9^*
cMCA-PI	0.98 ± 0.23	1.03 ± 0.23	1.02 ± 0.26
cCVR	30.1 ± 18.2		33.5 ± 17.4

Note:—CAS indicates carotid angioplasty stent placement; i, ipsilateral; MCA, middle cerebral artery; MFV, mean flow velocity; PI, pulsatility index; CVR, cerebrovascular reserve; c, contralateral.
* P < .05.
** P < .01.

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Table 4:

Clinical and TCD data of patients with TIA/stroke after stenting

Patient No. Age in Years	Clinical Symptoms and Time Onset	Grade of Ipsilateral and Contralateral Stenosis and Plaque Characteristics	MFV, PI of Ipsilateral MCA before, Early after CAS, and 30 Days Later	Basal Ipsilateral CVR and 30 Days after CAS
1, 72	Minor stroke: right brachial and facial weakness, 12 hours after CAS	95% left ICA, 80% right ICA, 22 mm, ulcerated plaque	40 cm/s, 0.75 55 cm/s, 0.89 45 cm/s, 0.93	12.5% 13.3%
2, 81	Two TIAs: right hand weakness, 9 hours and 15 hours after CAS	95% left ICA, no contralateral stenosis, 20 mm, ulcerated plaque	37 cm/s, 1.27 49 cm/s, 1.59 55 cm/s, 1.24	7.6% 11.4%
3, 76	Minor stroke: pure verbal deafness during CAS	99% right ICA, no contralateral stenosis, 30 mm, ulcerated calcium plaque	42 cm/s, 0.86 38 cm/s, 1.45 44 cm/s, 1.41	19.0% 75%
4, 80	TIA: left hemineglect and anosognosia, during CAS	99% right ICA, 50% left ICA, 10 mm, nonulcerated plaque	23 cm/s, 0.87 29 cm/s, 1.10 24 cm/s, 1.08	0% 50%

Note:—TCD indicates transcranial Doppler; TIA, transient ischemic attack; MFV, mean flow velocity; PI, pulsatility index; MCA, middle cerebral artery; CAS, carotid angioplasty stent placement; CVR, cerebrovascular reserve; ICA, internal carotid artery.