Computed tomography indicators of cerebral microperfusion improve long term after carotid stenting in symptomatic patients

Pawel J Winklewski; Mariusz Kaszubowski; Grzegorz Halena; Agnieszka Sabisz; Kamil Chwojnicki; Jarosław Dzierżanowski; Maciej Piskunowicz; Natalia Kurhaluk; Edyta Szurowska; Arkadiusz Szarmach

doi:10.18388/abp.2018_2793

Pawel J Winklewski 1Department of Human Physiology, Medical University of Gdansk, Gdańsk, Poland; 2Department of Clinical Anatomy and Physiology, Pomeranian University of Slupsk, Słupsk, Poland; 32-nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
Mariusz Kaszubowski Department of Economic Sciences, Gdansk University of Technology, Gdańsk, Poland
Grzegorz Halena Department of Cardiovascular Surgery, Medical University of Gdansk, Gdańsk, Poland
Agnieszka Sabisz 2-nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
Kamil Chwojnicki Department of Adults’ Neurology, Medical University of Gdansk, Gdańsk, Poland
Jarosław Dzierżanowski Department of Neurosurgery, Medical University of Gdańsk, Poland
Maciej Piskunowicz 1-st Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
Natalia Kurhaluk Department of Physiology, Pomeranian University of Slupsk, Słupsk, Poland
Edyta Szurowska 2-nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland
Arkadiusz Szarmach 2-nd Department of Radiology, Medical University of Gdansk, Gdańsk, Poland

DOI: https://doi.org/10.18388/abp.2018_2793

Abstract

Objectives: We tested the hypothesis that computed tomography (CT) perfusion markers of cerebral microcirculation would improve 36 months after internal carotid artery stenting for symptomatic carotid stenosis while results obtained 6–8 weeks after the stenting procedure would yield a predictive value. Methods: We recruited consecutive eligible patients with >70% symptomatic carotid stenosis with a complete circle of Willis and normal vertebral arteries to the observational cohort study. We detected changes in the cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and permeability surface area-product (PS) before and after carotid stenting. We have also compared the absolute differences in the ipsilateral and contralateral CT perfusion markers before and after stenting. The search for regression models of “36 months after stenting” results was based on a stepwise analysis with bidirectional elimination method. Results: A total of 34 patients completed the 36 months follow-up (15 females, mean age of 69.68±S.D. 7.61 years). At 36 months after stenting, the absolute values for CT perfusion markers had improved: CBF (ipsilateral: +7.76%, contralateral: +0.95%); CBV (ipsilateral: +5.13%, contralateral: +3.00%); MTT (ipsilateral: –12.90%; contralateral: –5.63%); TTP (ipsilateral: –2.10%, contralateral: –4.73%) and PS (ipsilateral: –35.21%, contralateral: –35.45%). MTT assessed 6–8 weeks after stenting predicted the MTT value 36 months after stenting (ipsilateral: R2=0.867, contralateral R2=0.688). Conclusions: We have demonstrated improvements in CT perfusion markers of cerebral microcirculation health that persist for at least 3 years after carotid artery stenting in symptomatic patients. MTT assessed 6–8 weeks after stenting yields a predictive value.