Middle cerebral artery flow after angioplasty and stenting of symptomatic internal carotid artery stenosis

Abstract

Background and purpose: Improved haemodynamics in the middle cerebral arteries (MCAs) after carotid artery endaterectomy (CEA) has been demonstrated in a number of studies, whereas similar analyses on carotid angioplasty and stenting (CAS) remain insignificant. The purpose of the study was to test whether CAS affects haemodynamic parameters of MCA ipsilaterally and contralaterally to the side of the procedure in patients with symptomatic internal carotid artery (ICA) stenosis, assessed by transcranial Doppler (TCD) examination.

Material and methods: Carotid angioplasty and stenting was performed in 51 patients (39 men and 12 women) aged 45-86 (mean age: men 65.5 years, women 69 years) after first ever ischaemic stroke. Patients were divided into three groups: with CAS of the left stenotic ICA - group I, with CAS of the right stenotic ICA - group II and group III with CAS of the left stenotic ICA and right ICA occlusion.

Results: Increase of MCAs flow after CAS was recorded both in ipsilateral MCAs and contralateral MCAs. Although an increase of MCAs flow was observed, it was not significant in either MCAs of group I and II patients, or in ipsilateral MCAs of individuals in group III. An evident increase of blood flow after CAS occurred in cMCAs of group III individuals. Similar results were received with reference to Gosling's pulsatility index.

Conclusions: Carotid angioplasty and stenting improves blood flow in both the ipsilateral and contralateral middle cerebral artery in patients with symptomatic carotid artery stenosis. Carotid angioplasty and stenting seems to be more effective in patients with symptomatic carotid artery stenosis combined with contralateral carotid artery occlusion than in individuals with symptomatic carotid artery stenosis alone.