Abstract
CEA contralateral to an ICA occlusion is considered a surgical risk, and CAS may be an alternative for these patients. Our goal was to examine whether CAS improves cerebral hemodynamics on the treated side and on the side of the ICA occlusion, on the basis of measurement of CBF and CVR by using SPECT. The subjects were 8 patients who underwent contralateral CAS. Resting CBF and CVR to acetazolamide were measured by using (123)I-IMP SPECT before and chronically (3-6 months) after CAS. Resting CBF was also measured immediately (<2 hours) after CAS by using (123)I-IMP SPECT. There were no significant differences in resting CBF in both hemispheres immediately after CAS. However, resting CBF and CVR both significantly increased in the chronic period in both hemispheres. Contralateral CAS in patients with ICA occlusion resulted in cerebral hemodynamic improvement on the treated side and on the side of ICA occlusion.
Highlights
70 AcomA ϩ FW PNote:—AG indicates AngioGuard XP; AcomA, anterior communicating artery; CG, carotid GuardWire; CW, carotid Wallstent; DP, distal protection device; FW, FilterWire EZ; mRS, modified Rankin Scale; P, Precise stent; PcomA, posterior communicating artery. a The period from insertion of a guiding catheter until the end of the procedure. b The period from inflation to deflation of a distal occlusion balloon in cases in which a Carotid GuardWire was used
Contralateral CAS in patients with ICA occlusion resulted in cerebral hemodynamic improvement on the treated side and on the side of ICA occlusion
“Cerebral hyperperfusion syndrome,” which is defined as a major increase in ipsilateral CBF to well above the metabolic demands of the brain tissue following the repair of carotid artery stenosis,[22,23] is a
Summary
Note:—AG indicates AngioGuard XP; AcomA, anterior communicating artery; CG, carotid GuardWire; CW, carotid Wallstent; DP, distal protection device; FW, FilterWire EZ; mRS, modified Rankin Scale; P, Precise stent; PcomA, posterior communicating artery. a The period from insertion of a guiding catheter until the end of the procedure. b The period from inflation to deflation of a distal occlusion balloon in cases in which a Carotid GuardWire was used. B The period from inflation to deflation of a distal occlusion balloon in cases in which a Carotid GuardWire was used. In the SPECT study performed within 2 hours after CAS, only resting CBF was measured by using the autoradiography method with a single administration of 123I-IMP and a single scan. The VOI template was modified in size and shape on the basis of individual SPECT images to determine the region-of-interest boundaries. In the cases in which a carotid GuardWire was used, we inflated the distal balloon for 1 minute before the procedure to confirm tolerability to transient occlusion, and no ischemic symptoms were observed. A paired t test was used to compare paired data (hematocrit, PaCO2, mean blood pressure, resting CBF, and CVR) between the preoperative and 2 postoperative SPECT studies. All calculations were performed by using StatView Version 5.0 software (SAS Institute, Cary, North Carolina)
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