IMPROVEMENT IN CEREBRAL HEMODYNAMICS AFTER CAROTID ANGIOPLASTY

Background and Purpose Carotid percutaneous transluminal angioplasty ( PTA) may offer an alternative treatment to carotid endarterectomy. How ever, in contrast to carotid endarterectomy, which has been shown to n ormalize impaired cerebral hemodynamics, the effects of carotid PTA ar e unknown. Therefore, we prospectively studied the effect of carotid P TA on both perioperative and postoperative cerebral hemodynamics. Meth ods Eleven patients undergoing carotid PTA for symptomatic carotid art ery stenosis were prospectively studied. Transcranial Doppler recordin gs from the ipsilateral middle cerebral artery (MCA) were performed du ring the procedure. In addition, MCA blood flow velocity and CO2 react ivity were determined before PTA and at 2 days, 1 month, and 6 months after the procedure. The results were compared with those in 11 simila r patients undergoing carotid endarterectomy in whom measurements were performed before and 1 month after the operation. Results During caro tid PTA, in 2 of 11 patients during passage of the balloon catheter th rough the stenosis, MCA blood flow velocity fell transiently. In 6 of 11 patients there was a reduction in flow velocity (>50%) during ballo on deflation, but this lasted only a few seconds. After the procedure there was a significant improvement in ipsilateral hypercapnic reactiv ity: preoperative value, 59.8+/-42.2% (mean+/-SD); 2 days, 77.9+/-31.4 %; 1 month, 88.7+/-45.0%; 6 months, 89.8+/-33.9%; and (ANOVA P=.003) p reoperative value versus 1 month, P<.02; versus 6 months, P<.02. In al l cases in which reactivity was significantly impaired preoperatively, it returned to the normal range. Pulsatility index also increased sig nificantly: preoperative value, 0.827+/-0.251 (mean+/-SD); 2 days, 0.9 92+/-0.262 (P=.002). Contralateral MCA hypercapnic reactivity also imp roved after carotid PTA. There was a similar improvement in ipsilatera l hypercapnic reactivity after carotid endarterectomy. Conclusions Car otid PTA results in a normalization of impaired hemodynamics, as asses sed by CO2 reactivity. The degree of improvement is similar to that se en after carotid endarterectomy.