Key result
Surgical treatment of symptomatic ≥70% ICA stenosis significantly increased cerebral blood flow in patients with low preoperative flow (increase of 277.18 ml/min, P=0.0000001).
Why the study?
Patients with ICA stenosis show elevated, undisrupted, or diminished cerebral blood flow, but the impact of ICA stenosis treatment on postoperative CBF changes relative to preoperative CBF values was unclear.
Does surgical intervention improve cerebral blood flow volume in patients with symptomatic ≥70% internal carotid artery stenosis?
Observational (n=58)
Does surgical intervention improve cerebral blood flow volume in patients with symptomatic ≥70% internal carotid artery stenosis?
Surgical treatment of symptomatic ICA stenosis significantly increases global cerebral inflow primarily in patients with lower preoperative cerebral blood flow, while causing flow redistribution in those with high preoperative flow.
Preoperative low CBF may identify patients gaining hemodynamic benefit from ICA stenosis surgery; leaves open whether DUS flow assessment should guide decisions.
BACKGROUND Among patients with ICA stenosis, there are some cases with elevated, undisrupted, and diminished cerebral blood flow (CBF). The aim of this study was to assess the influence of ICA stenosis treatment on postoperative CBF changes in relation to preoperative CBF values. MATERIAL AND METHODS We qualified 58 patients ≥65 years old (28 males, 30 females, mean age 71.02±6.34 years) for surgical intervention due to symptomatic ≥70% ICA stenosis. In all patients, a flow volume in all extracranial arteries (internal carotid [ICA], external carotid [ECA], and vertebral arteries [VA]) was measured preoperatively and 2-3 days following the surgery. The CBF values were compared with the ones established for a healthy population of the same age. RESULTS Preoperatively, there were 3 subgroups of patients, comparing to healthy population: with elevated CBF - "significant compensation," with undisrupted CBF - "mild compensation," and with diminished CBF - "no compensation." Postoperatively, a significant CBF increase was observed in patients with preoperative "no" and "mild compensation" - 277.18±154.26 ml/min (P=0.0000001) and 221.56±98.8 ml/min (P=0.0000001). In a "significant compensation" group, there was no flow increase observed (CBF change of 2.57±58.5 ml/min, P=0.954) - a redistribution of flow was observed. CONCLUSIONS In patients with lower preoperative CBF values, surgical treatment caused a significant increase in global cerebral inflow, which was more prominent in patients with the lowest preoperative CBF. In patients with high preoperative CBF, surgical treatment resulted in a flow redistribution, but did not cause a CBF increase. Volumetric flow assessment in DUS can predict hemodynamic benefit from surgery in terms of CBF increase.
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Kaszczewski et al. (2023) conducted an observational in symptomatic ≥70% internal carotid artery stenosis (n=58). Surgical intervention for ICA stenosis vs. Preoperative values was evaluated on Postoperative cerebral blood flow (CBF) changes. Surgical treatment of symptomatic ≥70% ICA stenosis significantly increased cerebral blood flow in patients with low preoperative flow (increase of 277.18 ml/min, P=0.0000001).
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