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- W2082772063 abstract "In this very interesting study by Oka et al,1Oka F. Ishihara H. Kato S. Oku T. Yamane A. Kunitugu I. et al.Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion.J Vasc Surg. 2013; 58: 1512-1517Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar the authors investigated cerebral hemodynamics in patients with near occlusion (NO) and severe carotid stenosis (≥70%) before and after carotid artery stenting (CAS). Cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) were measured using single-photon emission computed tomography. After CAS, the mean resting CBF and mean CVR were both significantly increased for patients with NO. In patients without NO, CVR increased significantly after CAS, and the mean resting CBF showed a tendency for an increase, but this was not significant.1Oka F. Ishihara H. Kato S. Oku T. Yamane A. Kunitugu I. et al.Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion.J Vasc Surg. 2013; 58: 1512-1517Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar Exhausted CVR reflects a situation where reduction of perfusion pressure leads to maximal cerebral vasodilatation. Reduced perfusion also induces impaired clearance of embolic material, increasing the risk of clinically manifested cerebral ischemia. Embolization and reduced vasodilatation act synergistically: when the capacity for cerebral vasodilatation is exhausted, emboli may more easily produce symptoms.2Sfyroeras G. Karkos C.D. Liasidis C. Spyridis C. Dimitriadis A.S. Kouskouras K. et al.The impact of carotid stenting on the hemodynamic parameters and cerebrovascular reactivity of the ipsilateral middle cerebral artery.J Vasc Surg. 2006; 44: 1016-1022Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 3Orlandi G. Fanucchi S. Gallerini S. Sonnoli C. Cosottini M. Puglioli M. et al.Impaired clearance of microemboli and cerebrovascular symptoms during carotid stenting procedures.Arch Neurol. 2005; 62: 1208-1211Crossref PubMed Scopus (45) Google Scholar Preoperative examination of the CVR helps to identify patients at increased risk for cerebral ischemia and hyperperfusion syndrome after CAS.2Sfyroeras G. Karkos C.D. Liasidis C. Spyridis C. Dimitriadis A.S. Kouskouras K. et al.The impact of carotid stenting on the hemodynamic parameters and cerebrovascular reactivity of the ipsilateral middle cerebral artery.J Vasc Surg. 2006; 44: 1016-1022Abstract Full Text Full Text PDF PubMed Scopus (26) Google Scholar, 3Orlandi G. Fanucchi S. Gallerini S. Sonnoli C. Cosottini M. Puglioli M. et al.Impaired clearance of microemboli and cerebrovascular symptoms during carotid stenting procedures.Arch Neurol. 2005; 62: 1208-1211Crossref PubMed Scopus (45) Google Scholar, 4Sfyroeras G.S. Karkos C.D. Arsos G. Liasidis C. Dimitriadis A.S. Papazoglou K.O. et al.Cerebral hyperperfusion after carotid stenting: a transcranial Doppler and SPECT study.Vasc Endovascular Surg. 2009; 43: 150-156Crossref PubMed Scopus (16) Google Scholar, 5Moulakakis K.G. Mylonas S.N. Sfyroeras G.S. Andrikopoulos V. Hyperperfusion syndrome after carotid revascularization.J Vasc Surg. 2009; 49: 1060-1068Abstract Full Text Full Text PDF PubMed Scopus (207) Google Scholar In the study by Oka et al,1Oka F. Ishihara H. Kato S. Oku T. Yamane A. Kunitugu I. et al.Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion.J Vasc Surg. 2013; 58: 1512-1517Abstract Full Text Full Text PDF PubMed Scopus (28) Google Scholar it would be useful to know if patients with and without NO who developed neurologic complications after CAS, attributed to both ischemia and hyperperfusion injury, had a preoperative exhausted CVR. Stress tests used to examine vascular reserves help therapeutic decisions in patients with coronary or peripheral artery disease. Management of patients with extracranial carotid artery disease is practically based on the percentage of stenosis and symptomatology, whereas CVR is a physiologic parameter that is often underevaluated. The examination of CVR increases our knowledge about the hemodynamic consequences of carotid narrowing and may help us to recognize patients at increased risk for complications during carotid revascularization. Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusionJournal of Vascular SurgeryVol. 58Issue 6PreviewThe natural history and management of patients with near occlusion (NO) of the internal carotid artery are controversial. In particular, it is unclear whether cerebral hemodynamics are compromised in these patients and whether improvement by carotid revascularization leads to the prevention of ischemic stroke. In this study, we measured cerebral blood flow (CBF) and cerebrovascular reactivity (CVR) using single-photon emission computed tomography before and after carotid artery stenting (CAS) for NO to examine the effectiveness of CAS from the perspective of cerebral hemodynamics. Full-Text PDF Open ArchiveReplyJournal of Vascular SurgeryVol. 59Issue 2PreviewThank you for your kind letter. Two patients in our series developed minor ischemic stroke during the perioperative period. Before carotid artery stenting (CAS), their resting cerebral blood flow and cerebrovascular reactivity (CVR) on the ipsilateral side of the middle cerebral artery area were 26.57 mL/100 g/min and 19.5% (for the near occlusion patient) and 28.98 mL/100 g/min and 28.5% (for the patient without near occlusion), respectively. Therefore, from our experience, exhausted CVR did not correlate with the ischemic cerebrovascular event after CAS. Full-Text PDF Open Archive" @default.
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- W2082772063 title "Regarding “Cerebral hemodynamic benefits after carotid artery stenting in patients with near occlusion”" @default.
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