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Evaluation of cerebrovascular reserve in asymp­tomatic patients with severe carotid artery stenosis


Authors: M. Špaček
Authors‘ workplace: Kardiologická klinika 2. LF UK a FN v Motole, Praha
Published in: Kardiol Rev Int Med 2015, 17(1): 11-14
Category: Cardiology Review

Overview

Atherosclerotic carotid artery disease (CAD) is an important risk factor for the development of stroke, which is a major cause of mortality, morbidity and disability in both developed and developing countries. Its prevalence increases with age and is proportional to the patient’s risk profile. Its manifestation however, is variable, with cerebral collateral circulation associated with cerebrovascular reserve (CVR) being considered a major modifying factor. The optimal treatment choice for asymp­tomatic CAD patients is a continuously debated topic with no clear consensus to date, requiring a strictly individual approach to every single patient. The evaluation of CVR using transcranial Doppler ultrasound (TCD) is straightforward in majority of patients and may significantly contribute to the optimal treatment selection process. This article summarizes the current knowledge regarding CVR and its evaluation using TCD.

Keywords:
cerebrovascular reserve –  transcranial Doppler ultrasound –  carotid artery stenting –  carotid endarterectomy –  breath‑ holding test


Sources

1. Donnan GA, Fisher M, Macleod M et al. Stroke. Lancet 2008; 371: 1612– 1613. doi: 10.1016/ S0140‑ 6736(08)60694‑ 7.

2. Sacco RL, Kargman DE, Gu Q et al. Race‑ ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. Stroke 1995; 26: 14– 20.

3. North American Symp­tomatic Carotid Artery Trial Collaborators. Beneficial effect of carotid endarterectomy in symp­tomatic patients with high‑grade carotid stenosis. N Engl J Med 1991; 325: 445– 453.

4. European Carotid Surgery Trialists’ Collaborative Group. MRC European Carotid Surgery Trial: interim results for symp­tomatic patients with severe (70– 99%) or mild (0– 29%) carotid stenosis. Lancet 1991; 337: 1235– 1243.

5. Brott TG, Hobson RW 2nd, Howard G et al. Stent­ing versus endarterectomy for treatment of carotid‑ artery stenosis. N Engl J Med 2010; 363: 11– 23. doi: 10.1056/ NEJMoa0912321.

6. White CJ. Carotid artery stenting. J Am Coll Cardiol 2014; 64: 722– 731. doi: 10.1016/ j.jacc.2014.04.069.

7. Executive Committee for the Asymp­tomatic Carotid Atherosclerosis Study. Endarterectomy for asymp­tomatic carotid artery stenosis. JAMA 1995; 273: 1421– 1428.

8. Halliday AW, Thomas D, Mansfield A. The Asymp­tomatic Carotid Surgery Trial (ACST). Rationale and design. Steering Committee. Eur J Vasc Surg 1994; 8: 703– 710.

9. Brott TG, Halperin JL, Abbara S et al. 2011 ASA/ ACCF/ AHA/ AANN/ AANS/ ACR/ ASNR/ CNS/  SAIP/ SCAI/ SIR/ SNIS/ SVM/ SVS Guideline on the Management of Patients With Extracranial Carotid and Vertebral Artery Disease A Report of the American College of Cardiology Foundation/ American Heart Association Task Force on Practice Guidelines, and the American Stroke Association, American Association of Neuroscience Nurses, American Association of Neurological Surgeons, American College of Radiology, American Society of Neuroradiology, Congress of Neurological Surgeons, Society of Atherosclerosis Imaging and Prevention, Society for Cardiovascular Angiography and Interventions, Society of Interventional Radiology, Society of NeuroInterventional Surgery, Society for Vascular Medicine, and Society for Vascular Surgery Developed in Collaboration With the American Academy of Neurology and Society of Cardiovascular Computed Tomography. J Am Coll Cardiol 2011; 57: e16– e94. doi: 10.1016/ j.jacc.2010.11.006.

10. Romero JR, Pikula A, Nguyen TN et al. Cerebral collateral circulation in carotid artery dis­ease. Curr Cardiol Rev 2009; 5: 279– 288. doi: 10.2174/ 157340309789317887.

11. Caplan LR, Hennerici M. Impaired clearance of emboli (washout) is an important link between hypoperfusion, embolism, and ischemic stroke. Arch Neurol 1998; 55: 1475– 1482.

12. Hetzel A, von Reutern GM, Wernz MG et al. The carotid compression test for therapeutic occlusion of the internal carotid artery. Cerebrovasc Dis 2000; 10: 194– 199.

13. Brozici M, van der Zwan A, Hillen B. Anatomy and functionality of leptomeningeal anastomoses: a review. Stroke 2003; 34: 2750– 2762.

14. Visser GH, Wieneke GH, van Huffelen AC et al. The use of preoperative transcranial Doppler variables to predict which patients do not need a shunt during carotid endarterectomy. Eur J Vasc Endovasc Surg 2000; 19: 226– 232.

15. Doblar DD, Plyushcheva NV, Jordan W et al. Predicting the effect of carotid artery occlusion during carotid endarterectomy: comparing transcranial doppler measurements and cerebral angiography. Stroke 1998; 29: 2038– 2042.

16. Liebeskind DS. Collateral circulation. Stroke 2003; 34: 2279– 2284.

17. Hoksbergen AW, Fulesdi B, Legernate AD et al. Collateral configuration of the circle of Willis: Trans­cranial color‑ coded duplex ultrasonography and comparison with postmortem anatomy. Stroke 2003; 31: 1346– 1351.

18. Iqbal S. A comprehensive study of the anatomical variations of the circle of willis in adult brains. J Clin Dia­gn Res 2013; 7: 2423– 2427. doi: 10.7860/ JCDR/ 2013/ 6580.3563.

19. Alpers BJ, Berry RG, Paddison RM. Anatomical studies of the circle of Willis in normal brain. AMA Arch Neurol Psychiat 1959; 81: 409– 418.

20. Špaček M, Veselka J. Invazivní léčba karotických stenóz a možnosti její optimalizace transkraniální dopplerovskou ultrasonografií. Kardiol Rev Int Med 2014; 16: 10– 14.

21. Alexandrov AV. The role of ultrasound in the management of cerebrovascular disease. In: Zwiebel WJ, Pellerito JS (eds.). Introduction to vascular ultrasound. 5th ed. Philadelphia: Elsevier Saunders 2005: 117.

22. Silvestrini M, Vernieri F, Pasqualetti P et al. Impaired cerebral vasoreactivity and risk of stroke in patients with asymp­tomatic carotid artery stenosis. JAMA 2000; 283: 2122– 2127.

23. Zavoreo I, Demarin V. Breath holding index and arterial stiffness as markers of vascular aging. Curr Aging Sci 2010; 3: 67– 70.

24. Gupta A, Chazen JL, Hartman M et al. Cerebrovascular reserve and stroke risk in patients with carotid stenosis or occlusion: a systematic review and meta‑analysis. Stroke 2012; 43: 2884– 2891. doi: 10.1161/ STROKEAHA.112.663716.

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