Document Detail


Interhemispheric asymmetry in brain perfusion before and after carotid stenting: a 99mTc-HMPAO SPECT study.
MedLine Citation:
PMID:  17154707     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
PURPOSE: To assess the effect of unilateral carotid angioplasty and stenting (CAS) on cerebral perfusion asymmetry in patients with severe extracranial carotid stenosis by means of technetium Tc 99m hexamethyl-propyleneamine oxime brain single photon emission computed tomography ((99m)Tc-HMPAO SPECT). METHODS: Twenty-nine consecutive patients (22 men; median age 68 years, range 58-80; 13 symptomatic) undergoing unilateral CAS were included in the study. Brain perfusion was assessed by (99m)Tc-HMPAO brain SPECT prior to the procedure and postoperatively at 8 hours and at 2 to 4 months. The asymmetry index (AI), a measure of the interhemispheric asymmetry in perfusion, was calculated as [(counts in "healthy" hemisphere-counts in hemisphere with carotid stenosis)/counts in "healthy" hemisphere]x100. RESULTS: The preoperative AI demonstrated a wide variation (mean -0.5%+/-8.4%, range -19.5% to 14.1%). There was no significant correlation between the degree of carotid stenosis and preoperative AI. The mean preoperative AI in the asymptomatic patients was lower than in the symptomatic group [-4.0%+/-8.5% (range -19.5% to 8.2%) versus 3.8%+/-6.4% (range -5.2% to 14.1%), p=0.01], suggesting reduced perfusion of the ipsilateral cerebral hemisphere compared to the contralateral side in symptomatic patients. AI variation did not improve after CAS; there was no difference in AI among the 3 SPECT studies (p=0.75). Preoperative AI correlated significantly with late AI (r=0.74, p<0.0001); however, there was no statistically significant correlation between immediate postoperative AI and either preoperative (r=0.24, p=0.217) or late (r=0.24, p=0.249) AI. CONCLUSION: Asymmetry in cerebral perfusion in patients with severe extracranial carotid atherosclerosis does not correlate with the degree of carotid stenosis. Symptomatic patients demonstrate compromised perfusion of the ipsilateral hemisphere compared to asymptomatic patients. As judged by (99m)Tc-HMPAO SPECT scanning, cerebral perfusion patterns do not significantly change after CAS.
Authors:
Giorgos S Sfyroeras; Georgios Arsos; Christos D Karkos; Charalampos Liasidis; Charalampos Spyridis; Dimitrios Boundas; Athanasios S Dimitriadis; Thomas S Gerassimidis
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Journal of endovascular therapy : an official journal of the International Society of Endovascular Specialists     Volume:  13     ISSN:  1526-6028     ISO Abbreviation:  J. Endovasc. Ther.     Publication Date:  2006 Dec 
Date Detail:
Created Date:  2006-12-12     Completed Date:  2007-01-11     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  100896915     Medline TA:  J Endovasc Ther     Country:  United States    
Other Details:
Languages:  eng     Pagination:  729-37     Citation Subset:  IM    
Affiliation:
5th Surgical Clinic, Medical School, Aristotle University of Thessaloniki, Hippocratio Hospital, Konstantinoupoleos 49, Thessaloniki 546 42, Greece.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Amaurosis Fugax / diagnosis,  etiology
Angiography, Digital Subtraction
Angioplasty, Balloon* / methods
Blood Vessel Prosthesis Implantation* / methods
Brain Ischemia / diagnosis,  etiology
Carotid Stenosis / complications,  diagnosis,  therapy*
Cerebrovascular Circulation*
Female
Follow-Up Studies
Humans
Ischemic Attack, Transient / diagnosis,  etiology
Linear Models
Magnetic Resonance Imaging
Male
Middle Aged
Radiopharmaceuticals / diagnostic use*
Severity of Illness Index
Stents*
Stroke / diagnosis,  etiology
Technetium Tc 99m Exametazime / diagnostic use*
Time Factors
Tomography, Emission-Computed, Single-Photon / methods*,  standards
Treatment Outcome
Chemical
Reg. No./Substance:
0/Radiopharmaceuticals; 100504-35-6/Technetium Tc 99m Exametazime

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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