Cerebral hemodynamics after contralateral carotid endarterectomy in patients with symptomatic and asymptomatic carotid occlusion: a 10-year follow-up
Journal of Cerebral Blood Flow & Metabolism advance online publication 4 January 2006; doi: 10.1038/sj.jcbfm.9600260
Claudio Baracchini1, Giorgio Meneghetti1, Renzo Manara1, Mario Ermani1 and Enzo Ballotta2
Received 29 September 2005; Revised 10 November 2005; Accepted 10 November 2005; Published online 4 January 2006.
Top of pageAbstract
We sought to investigate whether carotid endarterectomy (CEA) can achieve long-term cerebral hemodynamic improvement and reduce recurrence of cerebral ischemic events in symptomatic and asymptomatic patients with severe (>70%) carotid artery stenosis contralateral to carotid occlusion (CO). Thirty-nine patients with severe carotid lesion contralateral to CO were studied before (1 day) and after CEA (at 7 days, 1, 3 and 6 months, and then yearly thereafter). Collateral flow and cerebral vasomotor reactivity (VMR) were assessed by transcranial Doppler sonography (TCD). A total of 32 unoperated patients with severe carotid lesion contralateral to CO, who were comparable with respect to age and sex, served as a control group. The average period of TCD follow-up was 10 years and was obtained in all patients; during this period, major clinical events (stroke, acute myocardial infarction and death) were also recorded. The proportion of patients with collateral flow via the anterior communicating artery increased significantly from 61.5% before to 89.7% after CEA (P=0.01). Cerebral VMR ipsilateral to CO improved in 85.7% of patients (30 of 35) within 30 days of CEA, and in all patients within 90 days. No significant spontaneous VMR recovery was recorded in the control group. After the initial recovery, no significant change in VMR was observed in the surgical group or the control group during the follow-up. In conclusion, in patients with severe carotid stenosis, CEA contralateral to symptomatic and asymptomatic CO determines a durable cerebral hemodynamic improvement not only on the side of the CEA but also on the contralateral side, with no difference between symptomatic and asymptomatic patients.
症状性和无症状性颈内动脉闭塞的患者对侧颈动脉内膜剥脱术对血流动力学的影响.10年的随访研究
摘要:
我们的目的是研究对于症状性和无症状性颈动脉狭窄大于70%并对侧颈动脉闭塞的患者,颈动脉剥脱(CEA)是否可以获得长期的血液动力学的改善,并减少脑缺血事件的复发.对39例颈动脉严重狭窄并对侧闭塞的患者于CEA前(1天)和CEA后(7天,1,3,和6个月,以后每年)分别进行研究,应用TCD来评价侧枝血流和脑血管舒缩的反应性。共32名年龄、性别相当的伴有严重颈动脉损伤并对侧闭塞的非手术患者作为对照。所有患者TCD平均随访期限是10年，这期间，记录主要临床事件（卒中，急性心梗和死亡）。具有经前交通动脉的侧枝血流的患者的比例由CEA前的61.5%上升为术后的89.7%（p=0.01），CEA术后30天内85.7%的患者闭塞同侧脑血管舒缩反应性提高，90天内所有患者均有提高。而对照组未见明显的自发性改善。随访期间，未发现最初改善了的手术组和对照组患者的VMR再出现明显变化。
结论：对于颈动脉严重狭窄的患者，于症状性和无症状性闭塞的颈动脉的对侧行CEA，不但可以使CEA侧而且也使对侧获得持久性的脑血液动力学改善，而且与有无症状无关。
