ORIGINAL ARTICLE   

Italian Journal of Vascular and Endovascular Surgery 2023 March;30(1):11-4

DOI: 10.23736/S1824-4777.22.01572-8

Copyright © 2022 EDIZIONI MINERVA MEDICA

language: English

Carotid bifurcation stenosis: functional importance in physical exercises

Marina FEDORINA ¹ ✉, Igor DAVYDKIN ², Giuseppe GALATI ^{1, 3}, Giuseppe BIONDI-ZOCCAI ⁴, Olga GERMANOVA ¹

¹ International Center for Education and Research in Cardiovascular Pathology and Cardiovisualization, Samara State Medical University, Samara, Russia; ² Samara State Medical University, Samara, Russia; ³ Unit of Heart Failure, Division of Cardiology, Department of Cardiothoracic and Vascular Surgery, IRCCS San Raffaele Hospital, Milan, Italy; ⁴ Department of Medico-Surgical Sciences and Biotechnologies, Sapienza University, Rome, Italy

BACKGROUND: The aim of this study was to analyze the physical exercise effects on the cerebral arteries hemodynamics in stenosis of the internal carotid artery (ICA) (40-69%) in asymptomatic patients.
METHODS: One hundred twenty patients were divided into three main groups: 1) Group I (40) - without signs of carotid bifurcation atherosclerosis; 2) Group II (40) - with hemodynamically insignificant stenosis of the ICA (40-49%) (Group IIA - with stenosis of the ICA 50-59% [18]; Group IIB - 60-69% [22]; and 3) Group III (40) - with hemodynamically significant stenosis of the ICA (≥70%, without occlusion). All patients underwent hemostasiograms, lipid profile determination, ultrasound Doppler of brachiocephalic arteries, digital sphygmography (SG) of the common carotid artery (CCA), computed tomography of the brain, transcranial Dopper, stress echocardiography with bicycle ergometry, and study of hemodynamics in ICA stenosis area.
RESULTS: During the stress test, the majority of the patients (29 [72.5%]) of Group II experienced a volumetric blood flow decrease in the ICA, CCA on the side of stenosis. The kinetics SG parameters were lower in Group II, compared with Group I. There was a direct correlation between the degree of stenosis and the volumetric blood flow decrease. The parameters were close to the Group III patients’ data.
CONCLUSIONS: A “functional hemodynamically significant stenosis” of the ICA develops in stenosis of the ICA (40-69%), when a submaximal heart rate (HR) is reached. An additional indication for carotid endarterectomy is 40-69% stenosis and “functional hemodynamically significant stenosis.” We recommend performing the stress test to the patients with stenosis of the ICA (40-69%) to detect the development of “functional hemodynamically significant stenosis” in submaximal HR.

KEY WORDS: Vascular surgical procedures; Carotid artery, internal; Exercise