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
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