Key result
Carotid angioplasty with stenting significantly improved cerebral hemodynamics in the ipsilateral middle cerebral artery territory, demonstrated by reductions in normalized mean transit time (p<0.001) and time to peak (p=0.019).
Why the study?
Does carotid angioplasty with stenting improve cerebral perfusion parameters in patients with severe cervical carotid artery stenosis?
Observational (n=21)
Single-blind
No
Does carotid angioplasty with stenting improve cerebral perfusion parameters in patients with severe cervical carotid artery stenosis?
Absolute Event Rate: -3.46% vs -0.06%
p-value: p=<0.001
Carotid angioplasty with stenting in patients with severe stenosis leads to early improvements in cerebral hemodynamics, specifically reducing mean transit time and time to peak on perfusion-weighted MRI.
Stenting was associated with improved ipsilateral perfusion in severe stenosis; hypothesis-generating and requires RCTs before practice change.
Carotid artery stenosis due to arteriosclerosis increases the risk of cerebral ischemia via embolic phenomena or reduced blood flow. The changes in cerebral perfusion that may occur after treatment are not clearly understood. This study evaluated the changes in cerebral microcirculation following carotid angioplasty with stenting (CAS) under cerebral protection with filters using ultrafast gradient echo (GRE) perfusion weighted imaging (PWI) with magnetic resonance imaging (MRI). Prospectively, 21 cervical carotid stenosis patients, mean age 69.95 years, underwent MRI 12 h before and 72 h after CAS. PWI parameters were collected for statistical analysis: cerebral blood volume (CBV), mean transit time (MTT) and time to peak (TTP). Statistical analysis was applied to absolute parameters and to values normalized against those from the contralateral parenchyma. The main finding of this study was improved hemodynamics for the normalized data after CAS, shown by reduced MTT (p<0.001) and TTP (p=0.019) in the territory fed by the middle cerebral artery ipsilateral to the CAS. Absolute data showed increased blood volume in the cerebral hemispheres after CAS, which was more accentuated on the stent side (p=0.016) than the contralateral side (p=0.029). Early improvements in cerebral perfusion, mainly seen in the normalized data, were clearly demonstrated in the timing parameters - TTP & MTT - after CAS.
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Tavares et al. (2010) conducted an observational in Severe cervical carotid artery stenosis (n=21). Carotid angioplasty with stenting (CAS) vs. Pre-CAS baseline was evaluated on Normalized mean transit time difference (dMTT) between hemispheres (p=<0.001). Carotid angioplasty with stenting significantly improved cerebral hemodynamics in the ipsilateral middle cerebral artery territory, demonstrated by reductions in normalized mean transit time (p<0.001) and time to peak (p=0.019).
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