Cerebrovascular reactivity recovery following carotid angioplasty and stenting

Saher El-Sayed Hashem,Montaser Moawad Hegazy,Ahmed Ali El-Bassiony,Islam I Zaid,Ehab Shaker Belal,Sandra Mohamed Ahmed

doi:10.1186/s41983-019-0071-1

Abstract

BackgroundInternal carotid artery high-grade stenosis is a major cause of stroke. Carotid angioplasty and stenting (CAS) is a reasonable approach for treatment of certain patients. Cerebrovascular reactivity (CVR) evaluated through breath holding index test can assess the outcome following CAS.AimEvaluate changes in CVR before and after CAS.Subjects and methodThirty-two patients with 35 symptomatic internal carotid artery high-grade stenosis (> 70%) were enrolled by the mean of ultrasound screening. Breath holding index test was done using transcranial Doppler ultrasound before and after CAS.ResultsThe study includes 32 patients (22 males and 10 females). The mean age was 61.91 ± 6.59 years. The main risk factor was hypertension (75.3%). All patients showed an increase in mean flow velocity and BHI following CAS (P < 0.001) on both ipsilateral and contralateral side. Both groups (70–90% and > 90% stenosis) showed similar improvement of CVR.ConclusionCAS improves CVR in all high grades of internal carotid artery stenosis.

Highlights

Internal carotid atherosclerosis is one of the main causes of ischemic stroke
All patients showed an increase in mean flow velocity and breath holding index (BHI) following Carotid angioplasty and stenting (CAS) (P < 0.001) on both ipsilateral and contralateral side
It was found that recurrence of stroke in patients with significant carotid stenosis was as high as 26% 2 weeks following the first event [2]

Summary

Introduction

Internal carotid atherosclerosis is one of the main causes of ischemic stroke. It was found that recurrence of stroke in patients with significant carotid stenosis was as high as 26% 2 weeks following the first event [2]. Long-term follow up of patients used to favor endarterectomy rather than carotid angioplasty and stenting (CAS) [5], still, this later procedure is indicated and remains cost-effective for high-risk patients [6] as well as patients younger than 70 years. Internal carotid artery high-grade stenosis is a major cause of stroke. Carotid angioplasty and stenting (CAS) is a reasonable approach for treatment of certain patients. Cerebrovascular reactivity (CVR) evaluated through breath holding index test can assess the outcome following CAS. Subjects and method: Thirty-two patients with 35 symptomatic internal carotid artery high-grade stenosis (> 70%) were enrolled by the mean of ultrasound screening. Breath holding index test was done using transcranial Doppler ultrasound before and after CAS

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Discussion

Conclusion