Hemodynamic Surveillance of Unilateral Carotid Artery Stenting in Patients With or Without Contralateral Carotid Occlusion by TCD/TCCD in the Early Stage Following Procedure.

Ziguang Yan,Xiaoqiang Tong,Bihui Zhang,Min Yang,Guochen Niu,Hongjie Guo,Yinghua Zou

doi:10.3389/fneur.2019.00958

Ziguang Yan, Xiaoqiang Tong + Show 5 more

Open Access

https://doi.org/10.3389/fneur.2019.00958

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Abstract

Objective: To evaluate the cerebral hemodynamic variations in patients with unilateral carotid artery stenosis and contralateral carotid occlusion (CCO) in hours following carotid artery stenting (CAS) by transcranial Doppler (TCD) or transcranial color-code Doppler (TCCD).Methods: Sixty-five consecutive patients who underwent unilateral CAS were enrolled. Among them, 14 patients had ipsilateral severe stenosis and CCO (CCO group) while the other 51 patients had only unilateral severe carotid stenosis without CCO (UCS group). All patients underwent TCD or TCCD monitoring before, at 1 and 3 h after CAS. We monitored bilateral middle cerebral artery (MCA) peak systolic velocity (PSV), pulsatility index (PI), and blood pressure (BP), and compared that data between two groups.Results: In UCS group, ipsilateral MCA PSV increased relative to baseline at 1 h (96 ± 30 vs. 85 ± 26 cm/s, 15%, P < 0.001) and 3 h (97 ± 29 vs. 85 ± 26 cm/s, 17%, P < 0.001) following CAS. Significant PI increases were observed at 1 and 3 h following CAS on the ipsilateral side. In CCO group, ipsilateral MCA PSV increased relative to baseline at 1 h (111 ± 30 vs. 83 ± 26 cm/s, 35%, P < 0.001) and 3 h (107 ± 28 vs. 83 ± 26 cm/s, 32%, P <0.001) following CAS. The magnitude of ipsilateral MCA PSV increase was significantly higher in CCO group compared with UCS group at 1 h (P = 0.002) and 3 h (P = 0.024) following CAS, while BP similarly decreased between the two groups. On the contralateral side, significant MCA PSV increases were observed following CAS in CCO group but not in UCS group. Bilateral MCA PSV increases were higher in patients with a stenosis degree of ≥90% than in patients with stenosis degree of 70–89% only in CCO group.Conclusion: The ipsilateral MCA PSV and PI increase moderately in the initial hours after unilateral CAS in patients without CCO. In patients with CCO, the ipsilateral, and contralateral MCA PSV increase significantly in the early stage following CAS. CCO is a factor of the increased blood flow velocity in ipsilateral MCA after unilateral CAS.

Highlights

Contralateral carotid artery occlusion (CCO) was found in 5– 15% of carotid artery stenosis (CS) patients [1,2,3,4]
In CCO group, it is observed that ipsilateral middle cerebral artery (MCA) peak systolic velocity (PSV) increased significantly higher in patients with a ≥90% stenosis, which might be attributed to the impaired cerebral hemodynamic autoregulation
The maximum magnitude of MCA PSV increase was 84% in the ipsilateral side and 67% in the contralateral side. These results suggest that for patients with CCO, under a strict Blood pressure (BP) control and cerebral hemodynamic monitoring after carotid artery stenting (CAS), the risk for cerebral hyperperfusion syndrome (CHS) can be reduced

Summary

Introduction

Contralateral carotid artery occlusion (CCO) was found in 5– 15% of carotid artery stenosis (CS) patients [1,2,3,4]. According to the North American Symptomatic Carotid Endarterectomy Trial (NASCET), CCO has been demonstrated as an independent risk factor for carotid endarterectomy CEA [1, 2, 5, 6]. A crucial risk factor of periprocedural stroke following CAS is hemodynamic disturbance (HD), which often occurs within 6 h after CAS [8,9,10,11]. Only a few studies have evaluated cerebral hemodynamic changes in the early stage following CAS in patients with CCO. Transcranial Doppler (TCD) and transcranial color-code Doppler (TCCD) are bedside examinations and can be used for routine clinical monitoring of cerebral hemodynamic changes immediately after CAS [12].

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