Ischemic events after carotid interventions in relationship to baseline cerebrovascular reactivity.

BACKGROUND

We aimed to investigate whether baseline cerebrovascular reactivity could predict subsequent ischemic event after intervention and identify the patient group for more aggressive medical and interventional management paradigms.

METHODS

Patients with more than 70% cervical carotid stenosis (from ultrasonography) were reviewed. Patients, who had baseline cerebrovascular reactivity test before intervention and had either carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS) performed, were recruited for analysis. Transcranial Doppler ultrasonography was used to examine the reactivity of the middle cerebral artery in response to 5% carbon dioxide in oxygen. The mean follow up period was 66 months.

FINDINGS: Twenty-six patients had symptomatic carotid stenosis and ten patients had asymptomatic carotid stenosis. There were four subsequent ischemic events during follow up. None of the nine patients with impaired baseline ipsilateral cerebrovascular reactivity had subsequent ischemic event.

CONCLUSIONS

In this current study, impaired baseline cerebrovascular reactivity did not predict the subsequent stroke risk after carotid intervention. Cerebrovascular reactivity testing may not serve as an indicator for aggressive medical and surgical treatments.