From the Department of Radiology (M.K., J. vd G, M.A.V.) and Vascular
Surgery (B.C.E.), University Hospital Utrecht, Utrecht, the Netherlands.
Correspondence to Manon Kluytmans, Department of Radiology, University Hospital Utrecht, Room E01.334, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. E-mail manon.kluytmans{at}isi.uu.nl
Background and Purpose—The presence
and importance of hemodynamic factors to the beneficial
effect of carotid endarterectomy (CEA) in patients
with severe stenosis of the internal carotid artery (ICA) is
unclear. The purpose of this study was to investigate possible
hemodynamic changes caused by a severe ICA
stenosis and the subsequent changes after CEA.
Methods—Hemodynamic parameters were
acquired with dynamic susceptibility contrast MRI. Regional cerebral
blood volume (rCBV), mean transit time (MTT), time of appearance, and
time to peak were determined in 19 patients with severe
stenosis (>70%) of the ICA before and after CEA and in 33
control subjects. Four patients had an occlusion of the contralateral
ICA. Corresponding T2-weighted MRI and inversion recovery MRI scans
were used for segmentation of gray and white matter regions.
Results—In the hemisphere ipsilateral to the stenosed ICA,
no significant differences were found for the rCBV or MTT between
patients and control subjects. Also, no significant alterations in
these two parameters were observed after CEA. In the
hemisphere contralateral to the stenosed ICA,
hemodynamic changes were observed only in patients with
an ICA occlusion contralateral to the stenosed ICA. In these patients,
rCBV, MTT, time of appearance, and time to peak were all increased in
the contralateral hemisphere. After CEA, all
hemodynamic parameters fell in the normal
range.
Conclusions—Although CEA does improve the cerebral circulation in
patients with a severe stenosis and a contralateral ICA
occlusion, the hemodynamic effects of CEA in patients
with severe stenosis without a contralateral ICA occlusion are
negligible.
© 1998 American Heart Association, Inc.
Original Contributions
Long-Term Hemodynamic Effects of Carotid Endarterectomy
Key Words: carotid endarterectomy • hemodynamics • magnetic resonance imaging • perfusion
This article has been cited by other articles:
 |
|
 |
|
  A. P. Kansagra and E. C. Wong Quantitative Assessment of Mixed Cerebral Vascular Territory Supply With Vessel Encoded Arterial Spin Labeling MRI Stroke, November 1, 2008; 39(11): 2980 - 2985. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Kamouchi, K. Kishikawa, Y. Okada, T. Inoue, K. Toyoda, S. Ibayashi, and M. Iida Transoral Ultrasonographic Evaluation of Carotid Flow in Predicting Cerebral Hemodynamics after Carotid Endarterectomy AJNR Am. J. Neuroradiol., June 1, 2006; 27(6): 1295 - 1299. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. Soinne, J. Helenius, E. Saimanen, O. Salonen, P. J. Lindsberg, M. Kaste, and T. Tatlisumak Brain diffusion changes in carotid occlusive disease treated with endarterectomy Neurology, October 28, 2003; 61(8): 1061 - 1065. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
I. D. Wilkinson, P. D. Griffiths, N. Hoggard, T. J. Cleveland, P. A. Gaines, S. Macdonald, F. McKevitt, and G. S. Venables Short-Term Changes in Cerebral Microhemodynamics after Carotid Stenting AJNR Am. J. Neuroradiol., September 1, 2003; 24(8): 1501 - 1507. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
L. Soinne, J. Helenius, T. Tatlisumak, E. Saimanen, O. Salonen, P. J. Lindsberg, and M. Kaste Cerebral Hemodynamics in Asymptomatic and Symptomatic Patients With High-Grade Carotid Stenosis Undergoing Carotid Endarterectomy Stroke, July 1, 2003; 34(7): 1655 - 1661. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Bozzao, R. Floris, F. Gaudiello, V. Finocchi, L. M. Fantozzi, and G. Simonetti Hemodynamic Modifications in Patients with Symptomatic Unilateral Stenosis of the Internal Carotid Artery: Evaluation with MR Imaging Perfusion Sequences AJNR Am. J. Neuroradiol., September 1, 2002; 23(8): 1342 - 1345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Rutgers, C. J. M. Klijn, L. J. Kappelle, B. C. Eikelboom, A. C. van Huffelen, and J. van der Grond Sustained Bilateral Hemodynamic Benefit of Contralateral Carotid Endarterectomy in Patients With Symptomatic Internal Carotid Artery Occlusion Stroke, March 1, 2001; 32(3): 728 - 734. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Wiart, Y. Berthezene, P. Adeleine, P. Feugier, P. Trouillas, J.-C. Froment, and N. Nighoghossian Vasodilatory Response of Border Zones to Acetazolamide Before and After Endarterectomy : An Echo Planar Imaging-Dynamic Susceptibility Contrast-Enhanced MRI Study in Patients With High-Grade Unilateral Internal Carotid Artery Stenosis Stroke, July 1, 2000; 31(7): 1561 - 1565. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Ye, G. Dai, L. N. Ryner, P. Kozlowski, L. Yang, R. Summers, J. Sun, T. A. Salerno, R. L. Somorjai, and R. Deslauriers Unilateral Antegrade Cerebral Perfusion Through the Right Axillary Artery Provides Uniform Flow Distribution to Both Hemispheres of the Brain : A Magnetic Resonance and Histopathological Study in Pigs Circulation, November 9, 1999; 100(90002): II-309 - 315. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. P. Roddy, J. M. Estes, A. P. Harrington, P. A. Heggerick, T. F. O'Donnell Jr., and W. C. Mackey Comparison of Preoperative and Postoperative Duplex Ultrasound Evaluation of the Contralateral Carotid Artery Vascular and Endovascular Surgery, November 1, 1999; 33(6): 663 - 669. [Abstract] [PDF]
|
|