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

Abstract

Background: 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.

Purpose: 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.

Methods: Thirty-two patients (28 males and 4 females; age = 63.0 ± 7.3 years) 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 7 days prior to operations, and at 4 consecutive time-points (24, 48, 72, and 96 h) after operations. Comparisons within groups were made using paired t test, and comparisons between groups were made using independent-sample t test.

Results: The CBF values markedly increased at 24 h after CAS and CEA (P < 0.05) compared with baseline. Most patients showed peak CBF values on the ipsilateral side at 72 h (13/19, 68%) after CAS and at 48 h (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 96 h (P < 0.05).

Conclusions: 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.

Keywords: 3D pseudo-continuous arterial spin labeling; Carotid artery stenting; Cerebral blood flow; Endarterectomy.