Key result
CAS yields ~35% greater increase in MCA peak systolic velocity in near occlusion versus severe stenosis.
Why the study?
Cerebral hemodynamic variations in patients with and without carotid artery near occlusion after carotid artery stenting remain unclear in the early hours post-procedure.
Does carotid artery stenting induce different cerebral hemodynamic variations in patients with near occlusion compared to those with severe stenosis without near occlusion?
Cohort (n=56)
Does carotid artery stenting induce different cerebral hemodynamic variations in patients with near occlusion compared to those with severe stenosis without near occlusion?
Absolute Event Rate: 51% vs 16%
p-value: p=<0.001
Carotid artery stenting induces a greater increase in ipsilateral middle cerebral artery peak systolic velocity in patients with near occlusion compared to those with severe stenosis, highlighting the utility of transcranial Doppler for early hemodynamic monitoring.
Greater post-CAS MCA-PSV rise in near occlusion may support TCD monitoring; hypothesis-generating and leaves open tailored strategies.
BACKGROUND: To evaluate the unclear cerebral hemodynamic variations in patients with and without near occlusion (NO) in hours after carotid artery stenting (CAS) by transcranial Doppler (TCD). METHODS: Data of 56 patients (11 patients with carotid artery NO and 45 patients with severe stenosis without NO) who underwent unilateral CAS were analyzed. All patients underwent TCD or transcranial color-code Doppler monitoring before CAS and again at one and three hours after the procedure. We compared bilateral middle cerebral artery peak systolic velocity (MCA-PSV), pulsatility index (PI), and blood pressure (BP) data between the two groups. RESULTS: Ipsilateral MCA-PSV increased relative to baseline in the stenosis group at one hour (97 ± 30 vs. 84 ± 23 cm/s, 16%, P < 0.001) and three hours (96 ± 28 vs. 84 ± 23 cm/s, 15%, P < 0.001) after CAS. Corresponding increases were distinctly higher in the NO group than in the stenosis group at one hour (116 ± 37 vs. 80 ± 29 cm/s, 51%, P < 0.001) and three hours (113 ± 39 vs. 80 ± 29 cm/s, 46%, P = 0.001) after CAS, whereas BP decreased similarly between the two groups. The ipsilateral PI increased postsurgically in both groups, whereas contralateral MCA-PSV was unaltered. CONCLUSIONS: CAS can induce a significant increase in PSV and PI in ipsilateral MCA within three hours in patients with NO or severe stenosis but absent NO. The increment of ipsilateral MCA-PSV was greater in patients with NO. TCD can facilitate BP control in the early stage after CAS in patients with NO.
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Yan et al. (2019) conducted a cohort in Carotid artery stenosis with or without near occlusion (n=56). Carotid artery near occlusion vs. Severe stenosis without near occlusion was evaluated on Increase in ipsilateral middle cerebral artery peak systolic velocity (MCA-PSV) at one hour after CAS (p=<0.001). Carotid artery stenting caused a greater increase in ipsilateral middle cerebral artery peak systolic velocity at 1 hour in patients with near occlusion versus severe stenosis (51% vs 16%; P<0.001).
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