J Neurol Res

Journal of Neurology Research, ISSN 1923-2845 print, 1923-2853 online, Open Access

Article copyright, the authors; Journal compilation copyright, J Neurol Res and Elmer Press Inc

Journal website http://www.neurores.org

Original Article

Volume 5, Number 4-5, October 2015, pages 233-245

Parameters of Hemodynamic Instability Measured by Transcranial Doppler in Patients Undergoing Carotid Endarterectomy and Carotid Angioplasty-Stent: Comparison Between Groups

Figure 1. Hemodynamic parameter forms. FA: flow acceleration; SV: systolic velocity; DV: diastolic velocity; MV: mean velocity.

Figure 2. (a, b) Brain hemodynamic reserve correlations. Homolat-BHI: homolateral breath holding index; MV: mean velocity; Homolat delay: delay in flow acceleration; PCC: Pearson’s coefficient correlation.

Figure 3. (a, b, c) MV and PI asymmetries correlations. MV: mean velocity; PI: pulsatility index; PCC: Pearson’s coefficient correlation.

Figure 4. (a, b) Groups of patients according to percent MV asymmetry and percent MV change after the intervention. MV: mean velocity; CEA: carotid endarterectomy; CAS: carotid angioplasty-stenting.

**Table 1.** Epidemiologic and Clinical Characteristics
	CEA, n (%)	CAS, n (%)	P
Sex, male, n (%)	20 (80%)	25 (89%)
Age, mean ± standard deviation	68.1 ± 7.9	70.8 ± 10.3
HT
No	6 (24%)	7 (26%)	0.80
Control HT	15 (60%)	17 (60%)	0.80
Non-control HT	4 (16%)	4 (14%)	0.50
Diabetes mellitus
No	15 (60%)	17 (60%)	0.80
Control DM	9 (36%)	8 (29%)	0.70
Non-control DM	1 (4%)	3 (11%)	0.30
Dyslipemia
No	12 (48%)	21 (75%)	0.04
Control DL	12 (48%)	6 (21%)	0.04
Non-control DL	1 (4%)	1 (4%)	0.70
Chronic lower limb ischemia
No	20 (80%)	25 (89%)	0.20
Yes	5 (20%)	3 (11%)
Ischemic heart disease
No	17 (68%)	19 (68%)	0.90
Angor	4 (16%)	5 (18%)	0.50
AMI > 6 m	4 (16%)	4 (14%)	0.50
AMI < 6 m	0 (0%)	0 (0%)
Arrhythmias
No	22 (88%)	26 (92%)	0.40
AF	3 (12%)	1 (4%)	0.30
PM	0 (0%)	0 (0%)
Others	0 (0%)	1 (4%)
Cardiomyopathy
No	25 (100%)	24 (86%)	0.05
Dilated	0 (0%)	4 (14%)
Hypertrophy	0 (0%)	0 (0%)
Other	0 (0%)	0 (0%)
Valvular disease
No	23 (92%)	27 (96%)	0.40
AO	0 (0%)	1 (4%)
MI	1 (4%)	0 (0%)
Several	1 (4%)	0 (0%)
Cardiovascular disease
No	25 (100%)	27 (96%)	0.50
Systemic venous thrombosis	0 (0%)	1 (4%)
Systemic prothrombotic disease
No	23 (92%)	27 (96%)	0.40
Hematologic diseases	2 (8%)	1 (4%)
Neoplasm
No	24 (96%)	21 (74%)	0.03
Yes	1 (4%)	7 (26%)

Table 1. Epidemiologic and Clinical Characteristics

CEA, n (%)

CAS, n (%)

Sex, male, n (%)

20 (80%)

25 (89%)

Age, mean ± standard deviation

68.1 ± 7.9

70.8 ± 10.3

6 (24%)

7 (26%)

0.80

Control HT

15 (60%)

17 (60%)

0.80

Non-control HT

4 (16%)

4 (14%)

0.50

Diabetes mellitus

15 (60%)

17 (60%)

0.80

Control DM

9 (36%)

8 (29%)

0.70

Non-control DM

1 (4%)

3 (11%)

0.30

Dyslipemia

12 (48%)

21 (75%)

0.04

Control DL

12 (48%)

6 (21%)

0.04

Non-control DL

1 (4%)

0.70

Chronic lower limb ischemia

20 (80%)

25 (89%)

0.20

Yes

5 (20%)

3 (11%)

Ischemic heart disease

17 (68%)

19 (68%)

0.90

Angor

4 (16%)

5 (18%)

0.50

AMI > 6 m

4 (16%)

4 (14%)

0.50

AMI < 6 m

0 (0%)

Arrhythmias

22 (88%)

26 (92%)

0.40

3 (12%)

1 (4%)

0.30

0 (0%)

Others

0 (0%)

1 (4%)

Cardiomyopathy

25 (100%)

24 (86%)

0.05

Dilated

0 (0%)

4 (14%)

Hypertrophy

0 (0%)

Other

0 (0%)

Valvular disease

23 (92%)

27 (96%)

0.40

0 (0%)

1 (4%)

0 (0%)

Several

1 (4%)

0 (0%)

Cardiovascular disease

25 (100%)

27 (96%)

0.50

Systemic venous thrombosis

0 (0%)

1 (4%)

Systemic prothrombotic disease

23 (92%)

27 (96%)

0.40

Hematologic diseases

2 (8%)

1 (4%)

Neoplasm

24 (96%)

21 (74%)

0.03

Yes

1 (4%)

7 (26%)

**Table 2.** Characterization of Carotid Revascularized Stenosis
	CEA, n (%)	CAS, n (%)	P
Symptomatic stenoses, n (%)	13 (52%)	23 (82.1%)	0.02
Left side (n)	17	19	0.009
Delay time (n symptomatic) (days) mean, median (rank)	13, 59.62, 23 (7 - 210)	23, 24.43, 18 (7 - 90)	0.01
Contralateral significant stenoses (n)	11	24	0.004
Homolateral high-grade stenoses	9	11	0.028
Reperfusion syndrome	2 (8%)	4 (15%)	0.674
Other complications	21 (84%)	5 (18%)	< 0.001

Table 2. Characterization of Carotid Revascularized Stenosis

CEA, n (%)

CAS, n (%)

Symptomatic stenoses, n (%)

13 (52%)

23 (82.1%)

0.02

Left side (n)

0.009

Delay time (n symptomatic) (days) mean, median (rank)

13, 59.62, 23 (7 - 210)

23, 24.43, 18 (7 - 90)

0.01

Contralateral significant stenoses (n)

0.004

Homolateral high-grade stenoses

0.028

Reperfusion syndrome

2 (8%)

4 (15%)

0.674

Other complications

21 (84%)

5 (18%)

< 0.001

**Table 3.** TCD Hemodynamic Parameters in Both Groups
	CEA, median (min - max)	ASC, median (min - max)	P
%dif.: % of difference between both CMA MV; s: seconds; %MV: % of change in MV; BHI: breath holding index.
MV asymmetry between MCA (% dif.)	16 (-45 - +65)	21.5 (-62 - +68)	0.40
PI asymmetry between MCA (% dif.)	16 (-25 - +62)	17 (-45 - +71)	0.90
Systolic delay
Homolateral (s)	0.12 (0.05 - 0.20)	0.12 (0.05 - 0.21)	0.50
Contralateral (s)	0.06 (0.04 - 0.23)	0.06 (0.03 - 0.18)	0.70
Hemodynamic reserve (% MV)
Homolateral	21.7 (8 - 49)	20.80 (9 - 54)	0.50
Contralateral	36 (20 - 70)	35.30 (12 - 98)	0.90
Hemodynamic reserve (BHI)
Homolateral	0.5 (0.2 - 1.2)	0. 5 (0.3 - 1.7)	0.40
Contralateral	0.9 (0.6 - 1.5)	1.05 (0.3 - 2.4)	0.50
	CEA, n (%)	CAS, n (%)	P
Inverse ophthalmic artery yes/no	8 (65%)	19 (73%)	0.30
No. collaterals (no ophthalmic)
0 collaterals	2 (15%)	3 (11%)	0.50
1 collaterals	8 (62%)	9 (35%)	0.20
2 collaterals	3 (23%)	7 (27%)	0.50
3 collaterals	0 (0%)	7 (27%)	0.04
Other findings TCD
No	16 (89%)	13 (52%)	0.05
Contralateral stenosis	0 (0%)	7 (28%)	0.01
VB proximal stenosis	1(6%)	4 (16%)	0.20
Subclavian steel	1 (6%)	1 (4%)	0.60

Table 3. TCD Hemodynamic Parameters in Both Groups

CEA, median (min - max)

ASC, median (min - max)

%dif.: % of difference between both CMA MV; s: seconds; %MV: % of change in MV; BHI: breath holding index.

MV asymmetry between MCA (% dif.)

16 (-45 - +65)

21.5 (-62 - +68)

0.40

PI asymmetry between MCA (% dif.)

16 (-25 - +62)

17 (-45 - +71)

0.90

Systolic delay

Homolateral (s)

0.12 (0.05 - 0.20)

0.12 (0.05 - 0.21)

0.50

Contralateral (s)

0.06 (0.04 - 0.23)

0.06 (0.03 - 0.18)

0.70

Hemodynamic reserve (% MV)

Homolateral

21.7 (8 - 49)

20.80 (9 - 54)

0.50

Contralateral

36 (20 - 70)

35.30 (12 - 98)

0.90

Hemodynamic reserve (BHI)

Homolateral

0.5 (0.2 - 1.2)

0. 5 (0.3 - 1.7)

0.40

Contralateral

0.9 (0.6 - 1.5)

1.05 (0.3 - 2.4)

0.50

CEA, n (%)

CAS, n (%)

Inverse ophthalmic artery yes/no

8 (65%)

19 (73%)

0.30

No. collaterals (no ophthalmic)

0 collaterals

2 (15%)

3 (11%)

0.50

1 collaterals

8 (62%)

9 (35%)

0.20

2 collaterals

3 (23%)

7 (27%)

0.50

3 collaterals

0 (0%)

7 (27%)

0.04

Other findings TCD

16 (89%)

13 (52%)

0.05

Contralateral stenosis

0 (0%)

7 (28%)

0.01

VB proximal stenosis

1(6%)

4 (16%)

0.20

Subclavian steel

1 (6%)

1 (4%)

0.60

**Table 4.** Percentage of Patients With MES Patterns Register by TCD in Different Moments of CEA and CAS
MES patients %	0	< 5	5 - 10	10 - 25	Moderate	Shower	Curtain
Dissection	84	16	0	0	0	0	0
Clamp	87.5	8.3	4.2	0	0	0	0
Clamp release	8.3	0	4.2	16.7	16.7	45.8	8.3
Handling	37.5	20.8	12.5	16.7	8.3	4.2	0
Navigators	7.1	28.6	14.3	28.6	21.4	0	0
Filter	0	30	0	0	40	20	10
Swell_1	13.6	18.3	13.6	13.6	27.3	13.6	0
Deflate_1	0	4.5	4.5	9.2	22.8	54.5	4.5
Stent	3.9	0	0	7.7	7.7	61.5	19.2
Swell_2	16.7	20.8	29.2	8.3	20.8	4.2	0
Deflate_2	8.3	0	4.3	20.8	33.3	33.3	0

Table 4. Percentage of Patients With MES Patterns Register by TCD in Different Moments of CEA and CAS

MES patients %

< 5

5 - 10

10 - 25

Moderate

Shower

Curtain

Dissection

Clamp

87.5

8.3

4.2

Clamp release

8.3

4.2

16.7

45.8

8.3

Handling

37.5

20.8

12.5

16.7

8.3

4.2

Navigators

7.1

28.6

14.3

28.6

21.4

Filter

Swell_1

13.6

18.3

13.6

27.3

13.6

Deflate_1

4.5

9.2

22.8

54.5

4.5

Stent

3.9

7.7

61.5

19.2

Swell_2

16.7

20.8

29.2

8.3

20.8

4.2

Deflate_2

8.3

4.3

20.8

33.3