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Abstract Details

Improving Cerebrovascular Reactivity After Carotid Endarterectomy Is Not Accompanied by Improvement in Endothelial Vasodilator Function
Cerebrovascular Disease and Interventional Neurology
P10 - Poster Session 10 (11:45 AM-12:45 PM)

A high-grade carotid atherosclerosis is known to compromise cerebrovascular reactivity (CVR), which may improve after CEA, a change often attributed to myogenic mechanisms. Apart from being a risk factor for stroke, impaired CVR is also suggested to reflect a generally impaired vascular system. We investigated whether changes in CVR are paralleled with signs of peripheral endothelial dysfunction.

Analysis of cerebrovascular reactivity and peripheral endothelial dysfunction in patients with a high-grade carotid stenosis undergoing carotid endarterectomy (CEA).

We included 61 patients with a high-grade carotid stenosis (≥70% by NASCET criteria), either asymptomatic or symptomatic without a visible infarction, scheduled for CEA, in the analysis. They underwent transcranial Doppler ultrasound (TCD) with breath-holding index (BHI) and noninvasive endothelial function testing (EndoPat®) prior to and 6 months after CEA, and their secondary prevention was optimized according to routine standard of care. The control group consisted of 40 strictly healthy age-matched individuals with no medication. 

At baseline, the patients had a higher BMI than controls (27.8 vs. 25.0).  BHI values were lower in patients (0.88 vs. 1.06, p=0.003), and there was no difference in the natural logarithm of reactive hyperemia index (Ln RHI) reflecting endothelial function (0.59 vs 0.69, p=.19).  At 6 months, the BHI of patients had improved significantly (0.95, p=0.01), but their Ln HRI appeared significantly lower indicating poorer endothelial function (0.54 vs. 0.69, p<0.01).

The positive effect of CEA on impaired CVR is a vascular bed-specific response which does not reflect improvement in general endothelial function in the course of other secondary preventive measures.

Lauri S. Soinne, MD, PhD (University of Helsinki)
Dr. Soinne has nothing to disclose.
No disclosure on file
Petra Ijas, MD (Helsinki University Hospital, Neurocenter, Department of Neurology) Petra Ijas, MD has received personal compensation in the range of $500-$4,999 for serving as a Consultant for Amgen.
Krista Nuotio Krista Nuotio has nothing to disclose.
No disclosure on file
Perttu J. Lindsberg, MD (Helsinki University Hospital) The institution of Dr. Lindsberg has received research support from Helsinki University Hospital District. The institution of Dr. Lindsberg has received research support from Sigrid Juselius foundation.