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ITALIAN JOURNAL OF VASCULAR AND ENDOVASCULAR SURGERY
A Journal on Vascular and Endovascular Surgery
Giornale Italiano di Chirurgia Vascolare 1999 December;6(4):251-9
language: English, Italian
Cerebral hemodynamic aspects of asymptomatic and symptomatic carotid stenoses
Lucertini G., Ermirio D., Belardi P.
University of Genoa Department of Vascular Surgery (Head: Prof. P. Belardi)
Background: Severe (equal to or greater than 70%) carotid stenoses were evaluated to compare asymptomatic stenoses with symptomatic cases with regard to cerebral hemodynamic aspects.
Methods: A retrospective study was carried out on a series of 122 cases of severe carotid stenoses (114 patients, 85 males and 29 females, with ages ranging from 49 to 80, mean±standard deviation 68.1±8.3). Two groups were formed: 1. Group of asymptomatic carotid stenoses (ACS, 72 cases, 59%); 2. Group of symptomatic carotid stenoses (SCS, 50 cases, 41%). The following parameters were used during the assessment: cerebral vasoreactivity (CVR in 115 cases), the ratio mean velocity of the middle cerebral artery after carotid clamping/mean velocity of the middle cerebral artery before carotid clamping ×100 (mv-MCA%, in 122 cases) and carotid back pressure (CBP in 122 cases). CVR, mv-MCA% and CBP in the two groups were compared using Student’s “t”-test for unpaired data.
Results: No statistically significant differences (p>0.05) were found between the two groups regarding CVR (47±23 vs 48±20, p=0.84), mv-MCA% (59±25% vs 51±30, p=0.18) and CBP (59±25 vs 52±23 mmHg, p=0.10).
Conclusions: Two considerations can be made on the basis of these data: 1. The hypothesis regarding the embolic pathogenesis of cerebral ischemia caused by extracranial carotid stenosis appears to be more likely than the hemodynamic pathogenesis; 2) Problems caused by cerebral hypoperfusion due to carotid clamping are present in both clinical conditions, whether symptomatic or asymptomatic.