The influence of carotid endarterectomy on cerebral blood flow in significant carotid stenosis-perfusion computed tomography study.

AIM: Carotid endarterectomy (CEA) is well recognized procedure in the treatment of patients with significant symptomatic internal carotid artery (ICA) stenosis. Operation reconstitutes physiologic blood flow in the ICA. The influence of CEA on cerebral perfusion (CP) is not well established. Some data suggest increased CP after stenosis correction however evidence in post-endarterectomy patients is scarce. Our aim was to investigate the influence of CEA in patients with symptomatic carotid stenosis on CP parameters by means of perfusion computed tomography (PCT). METHODS: Thirty-four patients with symptomatic severe carotid stenosis qualified for CEA were included. The baseline PCT of the brain according to standardized protocol was performed within 3 weeks prior to surgical procedure. The follow-up PCT was performed between 30-60th day postop. The following perfusion parameters were analyzed: cerebral blood flow (CBF), cerebral blood volume (CBV), peak enhancement intensity (PEI) and time to peak (TTP). Pre- and postoperative average values of these parameters were compared. RESULTS: No death/stroke occurred in the investigated group. Mean preoperative total CBF was 66.2 mL/100 g/min and was not dependent on the degree of the carotid stenosis or the presence of contralateral carotid artery stenosis. Mean postoperative total CBF was significantly lower (61.8 mL/100g/min, P<0.05). No significant changes in PEI, TTP and CBV were observed CONCLUSION: PCT of the brain reveals that CEA in patients with symptomatic carotid stenosis decreased total CBF especially in the contralateral hemisphere.