Article Figures & Data
Figures
- Fig. 1.
Images obtained in a representative case. A, A preoperative left common carotid artery angiogram shows severe ICA stenosis (anteroposterior view). B, Left CAS was performed and a postoperative angiogram reveals no significant residual stenosis (anteroposterior view). C and D, Preoperative SPECT shows hypoperfusion (C) and low cerebrovascular reactivity (D) in both hemispheres. In the right hemisphere, a steal phenomenon is detected (D). E and F, Postoperative SPECT obtained 3 months after CAS. The examination demonstrates increased resting CBF (E) and cerebrovascular reactivity (F) on both the ipsilateral and the contralateral carotid occluded sides.
Tables
Patient Age (yr)/Sex Symptom Degree of Stenosis (%) Collateral Flow DP Stent Maximum Balloon Size (mm) Procedure Timea (Occlusion Timeb) (min) Degree of Stenosis after CAS (%) Clinical Outcome (mRS) 1 73/M Asymptomatic 86 AcomA + CG P 5.0 31 5 0 PcomA + (8) 2 68/M Minor stroke (hemodynamic) 83 AcomA + CG P 4.0 32 5 0 PcomA − (12) 3 63/F Minor stroke (emboli) 80 AcomA + AG P 4.5 29 0 1 PcomA + 4 60/M Minor stroke (emboli) 80 AcomA + CG P 5.0 30 0 1 PcomA + (11) 5 81/M Asymptomatic 83 AcomA + CG P 4.0 25 0 0 PcomA − (7) 6 69/M TIA (hemodynamic) 90 AcomA + FW CW 4.0 32 0 0 PcomA + 7 80/M Minor stroke (emboli) 70 AcomA + FW P 5.0 31 5 0 PcomA + 8 69/M Minor stroke (hemodynamic) 80 AcomA + FW P 4.5 40 0 0 PcomA − Note:—AG indicates AngioGuard XP; AcomA, anterior communicating artery; CG, carotid GuardWire; CW, carotid Wallstent; DP, distal protection device; FW, FilterWire EZ; mRS, modified Rankin Scale; P, Precise stent; PcomA, posterior communicating artery.
↵a The period from insertion of a guiding catheter until the end of the procedure.
↵b The period from inflation to deflation of a distal occlusion balloon in cases in which a Carotid GuardWire was used.
- Table 3:
Hemodynamic changes in both cerebral hemispheres before, immediately after, and chronically after carotid artery stenting
Patient Side of CAS Side of ICA Occlusion Resting CBF (mL/100 g/min) CVR (%) Resting CBF (mL/100 g/min) CVR (%) Before CAS After CAS (<2 h) After CAS (3–6 mo) Before CAS After CAS (3–6 mo) Before CAS After CAS (<2 h) After CAS (3–6 mo) Before CAS After CAS (3–6 mo) 1 32.8 31.0 40.3 6.0 19.6 31.9 30.4 38.5 −1.1 −1.2 2 25.7 20.7 27.3 5.9 33.1 24.6 19.7 26.2 −6.3 15.8 3 27.6 23.2 27.8 30.0 39.2 23.4 19.4 23.3 17.8 32.4 4 24.4 30.9 29.5 7.3 44.4 19.7 24.2 23.3 10.3 36.2 5 25.3 25.6 26.2 48.4 54.0 19.2 21.5 23.1 3.4 5.0 6 27.9 27.9 34.5 26.6 59.9 26.0 27.0 32.7 20.0 18.0 7 31.3 29.3 32.5 30.1 28.2 32.8 31.3 30.6 16.7 24.9 8 18.5 17.0 19.9 38.0 51.6 18.9 16.9 20.2 33.2 45.2 Mean 26.7 ± 4.1 25.7 ± 4.8 29.7 ± 5.7a 24.0 ± 15.0 41.2 ± 12.9a 24.6 ± 5.1 23.8 ± 5.0 27.2 ± 5.8a 11.8 ± 12.0 22.0 ± 14.7a ↵a P < .05 vs preoperative data.
