Recovery of the blood pressure – cerebral flow relation after carotid stenting in elderly patients

Summary

Background. As a sensitive and convenient means for the cerebral hemodynamic monitoring, dynamic cerebral autoregulation testing could be especially useful in medical conditions where less invasive diagnostics and therapies are preferred. This study analysed the effect of carotid stenting on dynamic autoregulation in elderly patients focussing on the relation between blood pressure and cerebral blood flow velocity.

Methods. We examined 20 patients age 69 ± 8 years with coexisting cerebrovascular and medical risk factors before and at least six month after stenting of severe carotid stenoses. Data were compared to 24 age-matched healthy controls. Slow spontaneous oscillations were studied in continuous recordings of Transcranial Doppler and beat-to-beat blood pressure. Analysis was based on the “high-pass filter model”, which predicts a positive phase relationship between these oscillations.

Findings. Whereas phase shift angles were diminished (20.4 ± 14.1°) before stenting, after stenting these values were significantly increased to normal (48.1 ± 16.6°), to the level of controls (46.7 ± 15.9°). Medical conditions such as coronary artery disease, arterial hypertension, and dyslipidemia did not diminish this recovery. The level of increase was inversely correlated with the initial autoregulatory deficit (r = −0.68) which was largest with insufficient collateral blood supply and symptomatic carotid stenoses.

Conclusions. The study showed that an impaired cerebral autoregulation may recover after stent-guided carotid angioplasty even in the elderly with co-existing medical conditions. In this respect to regain vasomotor capability, patients with cerebrovascular risk factors seemed to benefit particularly.