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<meta name="DC.Title" content="Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis" />
<meta name="DC.Identifier" content="10.3174/ajnr.A2757" />
<meta name="DC.Date" content="2012-02-01" />
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<meta name="DC.Description" content="BACKGROUND AND PURPOSE: The introduction of CAS has led to increased treatment of both symptomatic and asymptomatic patients with internal carotid stenosis. This study was performed to compare the effect of stent placement on cerebral perfusion in symptomatic and asymptomatic patients using CT perfusion.

MATERIALS AND METHODS: We included 45 patients with carotid artery stenosis of ≥70% who underwent arterial stent placement. Thirty-one patients were treated because of symptoms; 14 asymptomatic patients were treated before coronary artery bypass grafting. Patients underwent CTP before and after stent placement. We calculated MTT, CBV, and CBF, and derived relative numbers that compared treated with untreated hemispheres: ratios of CBV and CBF and difference in MTT. We compared the effect of carotid stent placement on cerebral perfusion in symptomatic and asymptomatic patients.

RESULTS: All perfusion parameters changed significantly after treatment in symptomatic patients: rCBF increased from 0.81 to 0.93 ( P &lt; .001), rCBV decreased from 1.02 to 0.95 ( P &lt; .05), and dMTT decreased from 1.29 to 0.14 ( P &lt; .001). In asymptomatic patients only, rCBF changed significantly with an increase from 0.92 to 1.03 ( P &lt; .05). When we compared symptomatic and asymptomatic patients before treatment, rCBF in symptomatic patients was significantly lower. The decrease of rCBV after treatment in symptomatic patients resulted in a significantly lower value than in asymptomatic patients.

CONCLUSIONS: Carotid artery stent placement improves blood flow in the affected hemisphere in symptomatic and asymptomatic patients. CBF before treatment is more strongly impaired in patients with symptomatic carotid stenosis. Compensatory hyperemia on the symptomatic side before treatment (rCBV &gt; 1) turns into hypoxemia after treatment, suggesting impaired autoregulation in these patients.

CABG
:   coronary artery bypass grafting
CAS
:   carotid artery stenting
CEA
:   carotid endarterectomy
dMTT
:   difference in mean transit time
rCBF
:   ratio of cerebral blood flow
rCBV
:   ratio of cerebral blood volume" />
<meta name="DC.Contributor" content="L.G. Merckel" />
<meta name="DC.Contributor" content="J. Van der Heijden" />
<meta name="DC.Contributor" content="L.M. Jongen" />
<meta name="DC.Contributor" content="H.W. van Es" />
<meta name="DC.Contributor" content="M. Prokop" />
<meta name="DC.Contributor" content="A. Waaijer" />
<meta name="article:published_time" content="2012-02-01" />
<meta name="article:section" content="Brain" />
<meta name="citation_title" content="Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis" />
<meta name="citation_abstract" lang="en" content="&lt;h3&gt;BACKGROUND AND PURPOSE:&lt;/h3&gt;
&lt;p&gt;The introduction of CAS has led to increased treatment of both symptomatic and asymptomatic patients with internal carotid stenosis. This study was performed to compare the effect of stent placement on cerebral perfusion in symptomatic and asymptomatic patients using CT perfusion.&lt;/p&gt;&lt;h3&gt;MATERIALS AND METHODS:&lt;/h3&gt;
&lt;p&gt;We included 45 patients with carotid artery stenosis of ≥70% who underwent arterial stent placement. Thirty-one patients were treated because of symptoms; 14 asymptomatic patients were treated before coronary artery bypass grafting. Patients underwent CTP before and after stent placement. We calculated MTT, CBV, and CBF, and derived relative numbers that compared treated with untreated hemispheres: ratios of CBV and CBF and difference in MTT. We compared the effect of carotid stent placement on cerebral perfusion in symptomatic and asymptomatic patients.&lt;/p&gt;&lt;h3&gt;RESULTS:&lt;/h3&gt;
&lt;p&gt;All perfusion parameters changed significantly after treatment in symptomatic patients: rCBF increased from 0.81 to 0.93 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001), rCBV decreased from 1.02 to 0.95 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .05), and dMTT decreased from 1.29 to 0.14 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .001). In asymptomatic patients only, rCBF changed significantly with an increase from 0.92 to 1.03 (&lt;i&gt;P&lt;/i&gt; &amp;lt; .05). When we compared symptomatic and asymptomatic patients before treatment, rCBF in symptomatic patients was significantly lower. The decrease of rCBV after treatment in symptomatic patients resulted in a significantly lower value than in asymptomatic patients.&lt;/p&gt;&lt;h3&gt;CONCLUSIONS:&lt;/h3&gt;
&lt;p&gt;Carotid artery stent placement improves blood flow in the affected hemisphere in symptomatic and asymptomatic patients. CBF before treatment is more strongly impaired in patients with symptomatic carotid stenosis. Compensatory hyperemia on the symptomatic side before treatment (rCBV &amp;gt; 1) turns into hypoxemia after treatment, suggesting impaired autoregulation in these patients.&lt;/p&gt;" />
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<meta name="twitter:title" content="Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis" />
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<meta name="twitter:description" content="BACKGROUND AND PURPOSE: The introduction of CAS has led to increased treatment of both symptomatic and asymptomatic patients with internal carotid stenosis. This study was performed to compare the effect of stent placement on cerebral perfusion in symptomatic and asymptomatic patients using CT perfusion.

MATERIALS AND METHODS: We included 45 patients with carotid artery stenosis of ≥70% who underwent arterial stent placement. Thirty-one patients were treated because of symptoms; 14 asymptomatic patients were treated before coronary artery bypass grafting. Patients underwent CTP before and after stent placement. We calculated MTT, CBV, and CBF, and derived relative numbers that compared treated with untreated hemispheres: ratios of CBV and CBF and difference in MTT. We compared the effect of carotid stent placement on cerebral perfusion in symptomatic and asymptomatic patients.

RESULTS: All perfusion parameters changed significantly after treatment in symptomatic patients: rCBF increased from 0.81 to 0.93 ( P &lt; .001), rCBV decreased from 1.02 to 0.95 ( P &lt; .05), and dMTT decreased from 1.29 to 0.14 ( P &lt; .001). In asymptomatic patients only, rCBF changed significantly with an increase from 0.92 to 1.03 ( P &lt; .05). When we compared symptomatic and asymptomatic patients before treatment, rCBF in symptomatic patients was significantly lower. The decrease of rCBV after treatment in symptomatic patients resulted in a significantly lower value than in asymptomatic patients.

CONCLUSIONS: Carotid artery stent placement improves blood flow in the affected hemisphere in symptomatic and asymptomatic patients. CBF before treatment is more strongly impaired in patients with symptomatic carotid stenosis. Compensatory hyperemia on the symptomatic side before treatment (rCBV &gt; 1) turns into hypoxemia after treatment, suggesting impaired autoregulation in these patients.

CABG
:   coronary artery bypass grafting
CAS
:   carotid artery stenting
CEA
:   carotid endarterectomy
dMTT
:   difference in mean transit time
rCBF
:   ratio of cerebral blood flow
rCBV
:   ratio of cerebral blood volume" />
<meta name="og-title" property="og:title" content="Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis" />
<meta name="og-url" property="og:url" content="http://ajnr-stage2.stage.highwire.org/content/33/2/280" />
<meta name="og-site-name" property="og:site_name" content="American Journal of Neuroradiology" />
<meta name="og-description" property="og:description" content="BACKGROUND AND PURPOSE: The introduction of CAS has led to increased treatment of both symptomatic and asymptomatic patients with internal carotid stenosis. This study was performed to compare the effect of stent placement on cerebral perfusion in symptomatic and asymptomatic patients using CT perfusion.

MATERIALS AND METHODS: We included 45 patients with carotid artery stenosis of ≥70% who underwent arterial stent placement. Thirty-one patients were treated because of symptoms; 14 asymptomatic patients were treated before coronary artery bypass grafting. Patients underwent CTP before and after stent placement. We calculated MTT, CBV, and CBF, and derived relative numbers that compared treated with untreated hemispheres: ratios of CBV and CBF and difference in MTT. We compared the effect of carotid stent placement on cerebral perfusion in symptomatic and asymptomatic patients.

RESULTS: All perfusion parameters changed significantly after treatment in symptomatic patients: rCBF increased from 0.81 to 0.93 ( P &lt; .001), rCBV decreased from 1.02 to 0.95 ( P &lt; .05), and dMTT decreased from 1.29 to 0.14 ( P &lt; .001). In asymptomatic patients only, rCBF changed significantly with an increase from 0.92 to 1.03 ( P &lt; .05). When we compared symptomatic and asymptomatic patients before treatment, rCBF in symptomatic patients was significantly lower. The decrease of rCBV after treatment in symptomatic patients resulted in a significantly lower value than in asymptomatic patients.

CONCLUSIONS: Carotid artery stent placement improves blood flow in the affected hemisphere in symptomatic and asymptomatic patients. CBF before treatment is more strongly impaired in patients with symptomatic carotid stenosis. Compensatory hyperemia on the symptomatic side before treatment (rCBV &gt; 1) turns into hypoxemia after treatment, suggesting impaired autoregulation in these patients.

CABG
:   coronary artery bypass grafting
CAS
:   carotid artery stenting
CEA
:   carotid endarterectomy
dMTT
:   difference in mean transit time
rCBF
:   ratio of cerebral blood flow
rCBV
:   ratio of cerebral blood volume" />
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      <h1 class="highwire-cite-title" id="page-title">Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis</h1>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0">L.G. Merckel</span>, <span class="highwire-citation-author" data-delta="1">J. Van der Heijden</span>, <span class="highwire-citation-author" data-delta="2">L.M. Jongen</span>, <span class="highwire-citation-author" data-delta="3">H.W. van Es</span>, <span class="highwire-citation-author" data-delta="4">M. Prokop</span> and <span class="highwire-citation-author" data-delta="5">A. Waaijer</span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">February 2012,  </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">280-285; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata">DOI: https://doi.org/10.3174/ajnr.A2757 </span></div>
  
  
  
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<p id="p-2"><strong>BACKGROUND AND PURPOSE:</strong> The introduction of CAS has led to increased treatment of both symptomatic and asymptomatic patients with internal carotid stenosis. This study was performed to compare the effect of stent placement on cerebral perfusion in symptomatic and asymptomatic patients using CT perfusion.</p>
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<p id="p-3"><strong>MATERIALS AND METHODS:</strong> We included 45 patients with carotid artery stenosis of ≥70% who underwent arterial stent placement. Thirty-one patients were treated because of symptoms; 14 asymptomatic patients were treated before coronary artery bypass grafting. Patients underwent CTP before and after stent placement. We calculated MTT, CBV, and CBF, and derived relative numbers that compared treated with untreated hemispheres: ratios of CBV and CBF and difference in MTT. We compared the effect of carotid stent placement on cerebral perfusion in symptomatic and asymptomatic patients.</p>
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<p id="p-4"><strong>RESULTS:</strong> All perfusion parameters changed significantly after treatment in symptomatic patients: rCBF increased from 0.81 to 0.93 (<em>P</em> &lt; .001), rCBV decreased from 1.02 to 0.95 (<em>P</em> &lt; .05), and dMTT decreased from 1.29 to 0.14 (<em>P</em> &lt; .001). In asymptomatic patients only, rCBF changed significantly with an increase from 0.92 to 1.03 (<em>P</em> &lt; .05). When we compared symptomatic and asymptomatic patients before treatment, rCBF in symptomatic patients was significantly lower. The decrease of rCBV after treatment in symptomatic patients resulted in a significantly lower value than in asymptomatic patients.</p>
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<p id="p-5"><strong>CONCLUSIONS:</strong> Carotid artery stent placement improves blood flow in the affected hemisphere in symptomatic and asymptomatic patients. CBF before treatment is more strongly impaired in patients with symptomatic carotid stenosis. Compensatory hyperemia on the symptomatic side before treatment (rCBV &gt; 1) turns into hypoxemia after treatment, suggesting impaired autoregulation in these patients.</p>
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<h2>ABBREVIATIONS:</h2>
<dl id="def-list-1"><dt id="def-item-1">CABG<span class="def-item-dt-sep"></span></dt><dd>coronary artery bypass grafting<span class="def-item-dd-sep"></span></dd><dt id="def-item-2">CAS<span class="def-item-dt-sep"></span></dt><dd>carotid artery stenting<span class="def-item-dd-sep"></span></dd><dt id="def-item-3">CEA<span class="def-item-dt-sep"></span></dt><dd>carotid endarterectomy<span class="def-item-dd-sep"></span></dd><dt id="def-item-4">dMTT<span class="def-item-dt-sep"></span></dt><dd>difference in mean transit time<span class="def-item-dd-sep"></span></dd><dt id="def-item-5">rCBF<span class="def-item-dt-sep"></span></dt><dd>ratio of cerebral blood flow<span class="def-item-dd-sep"></span></dd><dt id="def-item-6">rCBV<span class="def-item-dt-sep"></span></dt><dd>ratio of cerebral blood volume</dd></dl>
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      <div class="highwire-cite-title">Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis</div>  
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      <div class="highwire-cite-title">Effect of Stenting on Cerebral CT Perfusion in Symptomatic and Asymptomatic Patients with Carotid Artery Stenosis</div>  
    	<div class="highwire-cite-authors"><span  class="highwire-citation-authors"><span class="highwire-citation-author first" data-delta="0"><span class="nlm-given-names">L.G.</span> <span class="nlm-surname">Merckel</span></span>, <span class="highwire-citation-author" data-delta="1"><span class="nlm-given-names">J.</span> <span class="nlm-surname">Van der Heijden</span></span>, <span class="highwire-citation-author" data-delta="2"><span class="nlm-given-names">L.M.</span> <span class="nlm-surname">Jongen</span></span>, <span class="highwire-citation-author" data-delta="3"><span class="nlm-given-names">H.W.</span> <span class="nlm-surname">van Es</span></span>, <span class="highwire-citation-author" data-delta="4"><span class="nlm-given-names">M.</span> <span class="nlm-surname">Prokop</span></span>, <span class="highwire-citation-author" data-delta="5"><span class="nlm-given-names">A.</span> <span class="nlm-surname">Waaijer</span></span></span></div>
  
    	<div class="highwire-cite-metadata"><span  class="highwire-cite-metadata-journal highwire-cite-metadata">American Journal of Neuroradiology </span><span  class="highwire-cite-metadata-date highwire-cite-metadata">Feb 2012, </span><span  class="highwire-cite-metadata-volume highwire-cite-metadata">33 </span><span  class="highwire-cite-metadata-issue highwire-cite-metadata">(2) </span><span  class="highwire-cite-metadata-pages highwire-cite-metadata">280-285; </span><span  class="highwire-cite-metadata-doi highwire-cite-metadata"><span class="label">DOI:</span> 10.3174/ajnr.A2757 </span></div>
  
  
  
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