The effect of carotid artery stenting on capillary transit time heterogeneity in patients with carotid artery stenosis

Author:

Arsava Ethem M1ORCID,Hansen Mikkel B2,Kaplan Berkan1,Peker Ahmet3ORCID,Gocmen Rahsan3,Arat Anil3,Oguz Kader K3,Topcuoglu Mehmet A1,Østergaard Leif24,Dalkara Turgay15

Affiliation:

1. Department of Neurology, Faculty of Medicine, Hacettepe University, Turkey

2. Department of Clinical Medicine, Center of Functionally Integrative Neuroscience, Aarhus University, Denmark

3. Department of Radiology, Faculty of Medicine, Hacettepe University, Turkey

4. Department of Neuroradiology, Aarhus University Hospital, Denmark

5. Institute of Neurological Sciences and Psychiatry, Hacettepe University, Turkey

Abstract

Introduction Carotid revascularisation improves haemodynamic compromise in cerebral circulation as an additional benefit to the primary goal of reducing future thromboembolic risk. We determined the effect of carotid artery stenting on cerebral perfusion and oxygenation using a perfusion-weighted MRI algorithm that is based on assessment of capillary transit-time heterogeneity together with other perfusion and metabolism-related metrics. Patients and methods A consecutive series of 33 patients were evaluated by dynamic susceptibility contrast perfusion-weighted MRI prior to and within 24 h of the endovascular procedure. The level of relative change induced by stenting, and relationship of these changes with respect to baseline stenosis degree were analysed. Results Stenting led to significant increase in cerebral blood flow ( p < 0.001), and decrease in cerebral blood volume ( p = 0.001) and mean transit time ( p < 0.001); this was accompanied by reduction in oxygen extraction fraction ( p < 0.001) and capillary transit-time heterogeneity ( p < 0.001), but an overall increase in relative capillary transit-time heterogeneity (RTH: CTH divided by MTT; p = 0.008). No significant change was observed with respect to cerebral metabolic rate of oxygen. The median volume of tissue with MTT > 2s decreased from 24 ml to 12 ml ( p = 0.009), with CTH > 2s from 29 ml to 19 ml ( p = 0.041), and with RTH < 0.9 from 61 ml to 39 ml ( p = 0.037) following stenting. These changes were correlated with the baseline degree of stenosis. Discussion: Stenting improved the moderate stage of haemodynamic compromise at baseline in our cohort. The decreased relative transit-time heterogeneity, which increases following stenting, is probably a reflection of decreased functional capillary density secondary to chronic hypoperfusion induced by the proximal stenosis. Conclusion: Carotid artery stenting, is not only important for prophylaxis of future vascular events, but also is critical for restoration of microvascular function in the cerebral tissue.

Funder

Türkiye Bilimler Akademisi

Publisher

SAGE Publications

Subject

Cardiology and Cardiovascular Medicine,Neurology (clinical)

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