(Stroke. 2001;32:728.)
© 2001 American Heart Association, Inc.
Original Contributions |
Sustained Bilateral Hemodynamic Benefit of Contralateral Carotid Endarterectomy in Patients With Symptomatic Internal Carotid Artery Occlusion
From the Departments of Radiology (D.R.R., J. van der G.), Neurology (C.J.M.K., L.J.K.), Vascular Surgery (B.C.E.), and Clinical Neurophysiology (A.C. van H.), University Medical Center Utrecht (University Hospital Utrecht, Medical Faculty Utrecht, and Wilhelmina Children’s Hospital) (Netherlands).
Correspondence to D.R. Rutgers, MD, Department of Radiology, E01.132, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. E-mail D.Rutgers{at}azu.nl
Background and Purpose—We sought to investigate whether in patients with a symptomatic internal carotid artery (ICA) occlusion, endarterectomy of a severe stenosis of the contralateral carotid artery can establish long-term cerebral hemodynamic improvement.
Methods—Nineteen patients were studied on average 1 month before and 6 months after contralateral carotid endarterectomy (CEA). Volume flow in the main extracranial and intracranial arteries was measured with MR angiography. Collateral flow via the circle of Willis and the ophthalmic arteries was studied with MR angiography and transcranial Doppler sonography, respectively. Cerebral metabolism and CO2 vasoreactivity were investigated with MR spectroscopy and transcranial Doppler sonography, respectively. Twelve nonoperated patients with a symptomatic ICA occlusion and contralateral ICA stenosis, who were matched for age and sex, served as control patients.
Results—In patients who underwent surgery, flow in the operated ICA increased significantly (P<0.05) and flow in the basilar artery decreased significantly (P<0.01) after CEA. On the occlusion side, mean flow in the middle cerebral artery increased significantly from 71 to 85 mL/min (P<0.05) after CEA. The prevalence of collateral flow via the anterior communicating artery to the occlusion side increased significantly (47% before and 84% after CEA; P<0.05), while the prevalence of reversed ophthalmic artery flow on the operation side decreased significantly (42% before and 5% after CEA; P<0.05). In the hemisphere on the side of the ICA occlusion, lactate was no longer detected after CEA in 80% of operated patients, whereas it was no longer detected over time in 14% of nonoperated patients (P<0.05). CO2 reactivity increased significantly in operated patients in both hemispheres (P<0.01).
Conclusions—Contralateral CEA in patients with a symptomatic ICA occlusion induces cerebral hemodynamic improvement not only on the side of surgery but also on the side of the ICA occlusion.
Key Words: carotid artery occlusion • carotid endarterectomy • magnetic resonance angiography • spectroscopy, nuclear, magnetic resonance • transcranial Doppler sonography
This article has been cited by other articles:
 |
|
 |
|
  C.K. Maltezos, N. Papanas, T.T. Papas, G.S. Georgiadis, C.K. Dragoumanis, J. Marakis, E. Maltezos, and M.K. Lazarides Changes in Blood Flow of Anterior and Middle Cerebral Arteries Following Carotid Endarterectomy: A Transcranial Doppler Study Vascular and Endovascular Surgery, November 1, 2007; 41(5): 389 - 396. [Abstract] [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]
|
|
|
|
|
|
R. Moftakhar, A. S. Turk, D. B. Niemann, S. Hussain, S. Rajpal, T. Cook, M. Geraghty, B. Aagaard-Kienitz, P. A. Turski, and G. C. Newman Effects of Carotid or Vertebrobasilar Stent Placement on Cerebral Perfusion and Cognition AJNR Am. J. Neuroradiol., August 1, 2005; 26(7): 1772 - 1780. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. M. Findlay Editorial Comment--Plaque Pathology and Patient Selection for Carotid Endarterectomy Stroke, February 1, 2005; 36(2): 257 - 258. [Full Text] [PDF]
|
|
|
|
|
|
W.-D. Niesen, M. Rosenkranz, B. Eckert, M. Meissner, C. Weiller, and U. Sliwka Hemodynamic Changes of the Cerebral Circulation after Stent-Protected Carotid Angioplasty AJNR Am. J. Neuroradiol., August 1, 2004; 25(7): 1162 - 1167. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Reinhard, M. Roth, T. Muller, B. Guschlbauer, J. Timmer, M. Czosnyka, and A. Hetzel Effect of Carotid Endarterectomy or Stenting on Impairment of Dynamic Cerebral Autoregulation Stroke, June 1, 2004; 35(6): 1381 - 1387. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D.R. Rutgers, C.J.M. Klijn, L.J. Kappelle, and J. van der Grond Recurrent Stroke in Patients With Symptomatic Carotid Artery Occlusion Is Associated With High-Volume Flow to the Brain and Increased Collateral Circulation Stroke, June 1, 2004; 35(6): 1345 - 1349. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. C.F. Jongen, C. L. Franke, L. M.P. Ramos, J. T. Wilmink, and J. van Gijn Direction of Flow in Posterior Communicating Artery on Magnetic Resonance Angiography in Patients With Occipital Lobe Infarcts Stroke, January 1, 2004; 35(1): 104 - 108. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.M. Rothwell, S.C. Howard, and J.D. Spence Relationship Between Blood Pressure and Stroke Risk in Patients With Symptomatic Carotid Occlusive Disease Stroke, November 1, 2003; 34(11): 2583 - 2590. [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]
|
|
|
|
 |
|
 Endarterectomy in High-Grade Stenosis and Contralateral Occlusion Journal Watch Neurology, June 8, 2001; 2001(608): 5 - 5. [Full Text]
|
|