Dynamic Cerebral Autoregulation After Carotid Endarterectomy

Zi-Duo Shen; Yang Qu; Peng Zhang; Guibin Wang; You Wang; Yi Yang; Baofeng Xu; Zhen-Ni Guo

doi:10.1177/15266028231213608

Dynamic Cerebral Autoregulation After Carotid Endarterectomy

J Endovasc Ther. 2023 Nov 28:15266028231213608. doi: 10.1177/15266028231213608. Online ahead of print.

Authors

Zi-Duo Shen¹, Yang Qu¹, Peng Zhang², Guibin Wang¹, You Wang¹, Yi Yang¹, Baofeng Xu¹, Zhen-Ni Guo^{1

2}

Affiliations

¹ Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
² Neuroscience Research Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.

PMID: 38014769
DOI: 10.1177/15266028231213608

Abstract

Objective: Studies have shown that dynamic cerebral autoregulation (dCA) is impaired in patients with severe internal carotid artery (ICA) stenosis and that carotid endarterectomy (CEA) may improve dCA in these patients. However, the time course of dCA changes in patients after CEA remains unclear. Therefore, this study aimed to investigate the effects of CEA on the dCA in patients with carotid artery stenosis at different time points.

Methods: This prospective study enrolled 44 patients (19 symptomatic stenosis patients and 25 asymptomatic stenosis patients) who underwent CEA and 44 age- and sex-matched controls. In the CEA group, the patients underwent dCA measurements at baseline, within 3 days, and 1 month after CEA. Transfer function parameters, phase difference (PD), and gain were used to quantify dCA. Changes in dCA before and after CEA were analyzed in detail.

Results: The bilateral PD of the patients before CEA was significantly lower than that of the control group. This damage did not improve within 3 days after surgery. One month after surgery, the PD on the affected side of the patients significantly improved compared with before surgery and reached the level of the control group. The PD of affected side across time points in symptomatic and asymptomatic stenosis patients is consistent with that in all patients.

Conclusions: The dCA level did not improve immediately after CEA but significantly improved 1 month after surgery. This suggests that the occurrence of stroke should be considered in the acute period after CEA surgery, and its preventive effect on stroke may be effective after 1 month.

Clinical impact: We found the dCA level did not improve immediately after CEA but significantly improved 1 month after surgury. This suggests that the occuttencce of stroke and surgical complications (such as cerebral hyperperfusion syndrome) associated with impaired dCA in the acute phase after CEA surgery should be of particular concern.

Keywords: carotid endarterectomy; dynamic cerebral autoregulation; internal carotid artery; surgery; time course.