Abstract
Dynamic cerebral autoregulation (DCA) capacity along with the degree of internal carotid artery (ICA) stenosis and characteristics of the plaque can also play an important role in selection of appropriate treatment strategy. This study aims to classify the patients with severe ICA stenosis according to preoperative state of DCA and to assess its dynamics after surgery. Thirty-five patients with severe ICA stenosis having different clinical type of disease underwent reconstructive surgery. DCA was assessed with transfer function analysis (TFA) by calculating phase shift (PS) between Mayer waves of blood flow velocity (BFV) and blood pressure (BP) before and after operation. In 18 cases, regardless of clinical type, preoperative PS on ipsilateral side was within the normal range and did not change considerably after surgery. In other 17 cases preoperative PS was reliably lower both in patients with symptomatic and asymptomatic stenosis. Surgical reconstruction led to restoration of impaired DCA evidenced by significant increase of PS in postoperative period. Our data suggest that regardless clinical type of disease various state of DCA may be present in patients with severe ICA stenosis. This finding can contribute to establishing the optimal treatment strategy, and first of all for asymptomatic patients. Patients with compromised DCA should be considered as ones with higher risk of stroke and first candidates for reconstructive surgery.
Highlights
Numerous randomized clinical trials demonstrated the benefit of surgical management of severe symptomatic internal carotid artery (ICA) stenosis for the treatment and prevention of ipsilateral cerebral ischemic events (European Carotid Surgery Trialist’s Collaborative Group, 1991; North American Symptomatic Carotid Endarterectomy Trial Collaborators, 1991)
It based on the concept that cerebral regulatory system functions as a high-pass filter that means that high-frequency fluctuations of blood pressure (BP) are normally passing through blood flow velocity (BFV) unimpeded while low-frequency oscillations are dampened
We prospectively examined a cohort of 42 consecutive patients with severe ICA stenosis (83 ± 9%) who were admitted to neurovascular department for surgical management
Summary
Numerous randomized clinical trials demonstrated the benefit of surgical management of severe symptomatic internal carotid artery (ICA) stenosis for the treatment and prevention of ipsilateral cerebral ischemic events (European Carotid Surgery Trialist’s Collaborative Group, 1991; North American Symptomatic Carotid Endarterectomy Trial Collaborators, 1991). Previous studies demonstrated clear postoperative normalization of DCA in severe ICA stenosis that is generally impaired ipsilaterally prior to surgical intervention (Reinhard et al, 2004; Tang et al, 2008) This finding is regarded as an important predictive indicator of stroke risk and poor functional outcome while choosing proper treatment strategy (Reinhard et al, 2003a; King et al, 2011; Gupta et al, 2012). This clinical study aims to classify the patients with severe ICA stenosis according to preoperative state of DCA and to assess its dynamics after surgical intervention in relation to postoperative outcome
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