ABSTRACT
BACKGROUND AND PURPOSE: Improved haemodynamics in the middle cerebral arteries (MCAs) after carotid artery endaterectomy (CEA) has been demonstrated in a number of studies, whereas similar analyses on carotid angioplasty and stenting (CAS) remain insignificant. The purpose of the study was to test whether CAS affects haemodynamic parameters of MCA ipsilaterally and contralaterally to the side of the procedure in patients with symptomatic internal carotid artery (ICA) stenosis, assessed by transcranial Doppler (TCD) examination. MATERIAL AND METHODS: Carotid angioplasty and stenting was performed in 51 patients (39 men and 12 women) aged 45-86 (mean age: men 65.5 years, women 69 years) after first ever ischaemic stroke. Patients were divided into three groups: with CAS of the left stenotic ICA - group I, with CAS of the right stenotic ICA - group II and group III with CAS of the left stenotic ICA and right ICA occlusion. RESULTS: Increase of MCAs flow after CAS was recorded both in ipsilateral MCAs and contralateral MCAs. Although an increase of MCAs flow was observed, it was not significant in either MCAs of group I and II patients, or in ipsilateral MCAs of individuals in group III. An evident increase of blood flow after CAS occurred in cMCAs of group III individuals. Similar results were received with reference to Gosling's pulsatility index. CONCLUSIONS: Carotid angioplasty and stenting improves blood flow in both the ipsilateral and contralateral middle cerebral artery in patients with symptomatic carotid artery stenosis. Carotid angioplasty and stenting seems to be more effective in patients with symptomatic carotid artery stenosis combined with contralateral carotid artery occlusion than in individuals with symptomatic carotid artery stenosis alone.
Subject(s)
Carotid Stenosis/therapy , Middle Cerebral Artery/diagnostic imaging , Middle Cerebral Artery/physiopathology , Stents , Aged , Aged, 80 and over , Angioplasty , Blood Flow Velocity , Carotid Artery, Internal/surgery , Female , Humans , Male , Middle Aged , Regional Blood Flow , Ultrasonography, Doppler, TranscranialABSTRACT
UNLABELLED: A low dobutamine dose (DOB) improves the systolic function of impaired myocardium. There are some data suggesting the improvement of left ventricular (LV) diastolic function as well. The aim of this work was to assess the influence of DOB on some left ventricular diastolic flow parameters: inflow curve profile and early inflow wave propagation velocity (Prop). MATERIAL AND METHODS: 33 persons (7 women and 26 men) aged 35-74, with a mean age of 53 and with an ejection fraction (EF) < 35% were examined. DOB was administered in doses of 5 and 10 micrograms/kg/min every 3 minutes. At the beginning of the examination (D-0) and at the end (D-1), the LV contractility and the following inflow parameters were assessed: E and A waves velocities, E/A-ratio on mitral orifice level (U) and at the half of LV (1/2 LV) and Prop. RESULTS: DOB increased the heart rate from 69.4/min to 74.4/min (p < 0.01) and improved the LV contractility in every case. We observed no significant changes of the E wave velocity influenced by DOB on U (D-O: 0.7 +/- 0.22 m/s; D-1: 0.68 +/- 0.2 m/s) and in 1/2 LV, or no E/A changes (D-O: 1.24 +/- 0.71; D-1 1.21 +/- 1.08 on U and D-O: 1.68 +/- 1.06; D-1: 1.64 +/- 1.16 in 1/2 LV). Statistically significant differences were recorded only between A in D-O and A in D-1 on both levels (p < 0.05): D-O was 0.66 +/- 0.21 m/s and D-1 was 0.71 +/- 0.22 m/s on U and D-O was 0.422 +/- 0.2 m/s and D-1 was 0.47 +/- 0.2 m/s in 1/2 LV. Significant Prop shortening was ascertained: from 39.4 +/- 10.9 cm/s to 45.4 +/- 16.1 cm/s; p < 0.01. The correlation registered at rest between Prop and EF (R = 0.4) and Prop and contractility index (R = -0.52), was recorded at a similar level after DOB as well. No correlation between Prop and heart rate was seen. CONCLUSIONS: 1. Dobutamine in low doses in subjects with impaired LV causes no significant heart rate acceleration and no progression in contractility disorders, improves LV diastolic function, expressed by early diastolic blood flow towards the apex (inflow propagation) acceleration. 2. Dobutamine in low dose increases mitral A wave velocity caused by improvement of LV diastolic function and/or improvement of LA contractility.
