Intracranial Blood Flow Changes in Patients with High-Grade Severe Carotid Artery Stenosis After Stenting

Abstract

We investigated whether the cerebral hemodynamic changes of pre- and poststenting in patients with severe carotid stenosis differ by stenosis grades. We prospectively recruited patients who underwent carotid artery stenting (CAS) after acute ischemic stroke from June 2014 to December 2015. We compared the mean relative cerebral blood flow (rCBF) changes (measured by whole-brain computed tomography perfusion) pre- and poststenting in patients with high-grade severe stenosis (HGSS) (90%-99%) versus patients with low-grade severe stenosis (LGSS) (70%-89%). Among 24 patients included in the study (mean age, 66.2 ± 7.2 years; 91.7% men), 62.5% (15/24) were in the HGSS group and 37.5% (9/24) were in the LGSS group. In the HGSS group, rCBF increased in territories of the anterior cerebral artery (P= 0.021), middle cerebral artery (P<0.001), posterior cerebral artery (P=0.001), and basil ganglia (P= 0.003) after stenting. Of the patients with HGSS, 53.3% (8/15) had collateral flow through anterior communicating artery (AcomA) prestenting. After stenting, all the AcomA collaterals in HGSS reverted to normal (P= 0.002). The improvement of brain perfusion combined with the normalization of collateral flow through the circle of Willis after CAS was observed only in patients with HGSS.