Key result
Following carotid endarterectomy, blood flow velocities transiently increased in the anterior Willis circle, with hyperperfusion syndrome manifesting in 14 patients.
Why the study?
Does carotid endarterectomy alter blood flow velocity in the anterior and middle cerebral arteries in patients with high-grade carotid stenosis or ischemic stroke?
Cohort (n=100)
Does carotid endarterectomy alter blood flow velocity in the anterior and middle cerebral arteries in patients with high-grade carotid stenosis or ischemic stroke?
Carotid endarterectomy induces a transient bilateral increase in anterior cerebral blood flow velocity that normalizes within 1 to 12 months and may be associated with hyperperfusion syndrome.
May warrant post-CEA TCD monitoring for hyperperfusion risk; leaves open predictive value in prospective cohorts.
AIM: The aim of the present study was to evaluate the changes in blood flow of anterior and middle cerebral arteries following carotid endarterectomy, using transcranial Doppler (TCD) flow studies. PATIENTS AND METHODS: This study included 100 patients (72 men, mean age 65 years) who underwent carotid endarterectomy because of high-grade carotid stenosis or symptoms of ischemic stroke. Endarterectomy was performed by a distal shunt between the common carotid and internal carotid arteries. Blood flow in the anterior and middle cerebral arteries was assessed by TCD preoperatively and also in the postoperative period (1st and 4th day; 1st, 6th, and 12th month). Collateral circulation in the Willis circle was evaluated by common carotid compression. RESULTS: Patients with bilateral carotid stenosis > or =70% exhibited a significantly increased flow velocity in the ipsilateral anterior cerebral artery (ACA), middle cerebral artery (MCA), and in the contralateral ACA. Patients with entirely occluded contralateral internal carotid artery showed the most pronounced changes in cerebral hemodynamics. Blood flow velocities returned to the preoperative values at 1 to 12 months following endarterectomy. Hyperperfusion syndrome was manifested in 14 patients, who exhibited significantly higher flow velocities in the ipsilateral MCA compared with asymptomatic patients. CONCLUSIONS: A transient bilateral increase of blood flow velocity in the anterior part of the Willis circle may often occur in the immediate postoperative period following carotid endarterectomy. Although its clinical significance is not entirely understood, this increase may be associated with cerebral hyperperfusion syndrome.
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Maltezos et al. (2007) conducted a cohort in High-grade carotid stenosis or symptoms of ischemic stroke (n=100). Carotid endarterectomy was evaluated on Changes in blood flow of anterior and middle cerebral arteries. Following carotid endarterectomy, blood flow velocities transiently increased in the anterior Willis circle, with hyperperfusion syndrome manifesting in 14 patients.
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