Longitudinal assessment of cerebral blood flow changes following carotid artery stenting and endarterectomy.

Abstract

Carotid artery stenting (CAS) and endarterectomy (CEA) are major treatment strategies for patients with internal carotid artery (ICA) stenosis; however, the dynamic cerebral blood flow (CBF) changes after CAS and CEA remain unclear. This study aimed to monitor consecutive CBF changes at 24-h intervals in patients who underwent CAS and CEA to explore the potential pattern of CBF alternation and compare the effect on CBF changes of different surgical methods. Thirty-two patients (28 males and 4 females; age = 63.0 ± 7.3years) with 70-99% ipsilateral stenosis in the ICA were enrolled, of which 19 underwent CAS and 13 underwent CEA by prospective cross-sectional study. Routine head MRI and three-dimensional pseudo-continuous arterial spin labeling were performed using a 3.0-T system within 7days prior to operations, and at 4 consecutive time-points (24, 48, 72, and 96h) after operations. Comparisons within groups were made using paired t test, and comparisons between groups were made using independent-sample t test. The CBF values markedly increased at 24h after CAS and CEA (P < 0.05) compared with baseline. Most patients showed peak CBF values on the ipsilateral side at 72h (13/19, 68%) after CAS and at 48h (10/13, 77%) after CEA, which then declined. The CBF values for the ipsilateral ICA territory of CEA group were higher than those of CAS group at 24, 48, 72, and 96h (P < 0.05). The pattern of dynamic CBF changes is different after CAS and CEA, which may be helpful for the improvement of the patient's postoperative management.