Skip to main content

Advertisement

SpringerLink
Log in

Effects of carotid endarterectomy on blood flow in the internal carotid artery

  • Published:
Acta Neurochirurgica Aims and scope Submit manuscript

Summary

A retrospective study of patients operated upon for carotid stenosis was undertaken with special emphasis on the internal carotid artery (ICA) blood flow. A total of 212 endarterectomies were performed in 198 patients. The overall operative mortality was 1.4%, and the cerebral morbidity was 2.8%. A temporary inlying shunt was used routinely during endarterectomy. In two of 198 endarterectomies the shunt itself could not be excluded as a possible cause of postoperative neurological deficits.

The ICA blood flow before and after endarterectomy was determined by electromagnetic flowmetry in 160 operations. Flow measurements were compared in TIA and stroke patients, in patients with high and low degrees of luminal constriction, and in patients with occluded or “open” (minimal stenosis) contralateral ICA.

The results indicate that the preoperative blood flow, as well as the increase in blood flow after removal of the stenosis, is determined not only by the degree of luminal constriction, but also by the magnitude of blood flow from all precerebral feeding arteries and their intracranial collateral circulation.

In treatment of carotid stenosis critical evaluation of symptoms, angiography, and haemodynamics are essential. Endarterectomy is beneficial because an embolic source is removed, and probably because perfusion is improved to areas of the brain with marginal circulation.

The main factors regulating the normal cerebral perfusion are cardiac output (mean perfusion pressure), arterial pCO2 and pO2, haematocrit, and the arterial and venous blood pressures.

Comparatively few investigations have been published on the effect of endarterectomy upon internal carotid artery (ICA) blood flow4, 12, 14, 27.

Since 1970 we have routinely measured the ICA blood flow before and after endarterectomy18. This paper reviews the clinical and haemodynamic results of our patients operated on for carotid stenosis.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Alpers, B. J., Berry, R. G., Circle of Willis in cerebrovascular disorders. Arch. Neurol.8 (1963), 398–402.

    PubMed  Google Scholar 

  2. Archie, J. P., Feldtman, R. W., Critical Stenosis of the internal carotid artery. Surg.89 (1981), 67–70.

    Google Scholar 

  3. Baker, W. H., Dorner, D. B., Barnes, R. W., Carotid endarterectomy: Is an indwelling shunt necessary? Surg.82 (1977), 321–326.

    Google Scholar 

  4. Boysen, G., Ladegaard-Pedersen, H. J., Valentin, N., Engell, H. C., Cerebral blood flow and internal carotid artery flow during carotid surgery. Stroke1 (1970), 253–260.

    PubMed  Google Scholar 

  5. Boysen, G., Cerebral blood flow measurement as a safeguard during carotid endarterectomy. Stroke2 (1971), 1–11.

    PubMed  Google Scholar 

  6. Boysen, G., Cerebral hemodynamics in carotid surgery. Acta Neurol. Scand.49 (1973), Suppl. 52.

  7. Connolly, J. E., Kwaan, J. H. M., Stemmer, E. A., Improved results with carotid endarterectomy. Ann. Surg.186 (1977), 334–340.

    PubMed  Google Scholar 

  8. Denny-Brown, D., Recurrent cerebrovascular episodes. Arch. Neurol.2 (1960), 194–210.

    PubMed  Google Scholar 

  9. De Weese, J. A., May, A. G., Lipchik, E. O., Rob, C. G., Anatomic and hemodynamic correlations in carotid artery stenosis. Stroke1 (1970), 149–158.

    PubMed  Google Scholar 

  10. Dickinson, C. J., Functional efficiency of the circle of Willis. Brit. Med. J. March25 (1961), 858–859.

    Google Scholar 

  11. Drake, W. E., Drake, M. A. L., Clinic and angiographic correlates of cerebrovascular insufficiency. Amer. J. Med.45 (1968), 253–270.

    PubMed  Google Scholar 

  12. Engell, H. C., Boysen, G., Ladegaard-Pedersen, H. J., Henriksen, H., Cerebral blood flow before and after carotid endarterectomy. Vasc. Surg.6 (1972), 14–19.

    PubMed  Google Scholar 

  13. Hays, R. J., Levinson, S. A., Wylie, E. J., Intraoperative measurement of carotid back pressure as a guide to operative management of carotid endarterectomy. Surg.72 (1972), 953–960.

    Google Scholar 

  14. Jennett, B., Miller, J. D., Harper, A. M., Effect of carotid artery surgery on cerebral blood flow. Excerpta Medica (1976).

  15. Kendell, R. E., Marshall, J., Role of hypotension in the genesis of transient focal cerebral ischemic attacks. Brit. Med. J.10 (1963), 344–348.

    Google Scholar 

  16. Meyer, J. S., Shimazu, K., Fukuuchi, Y.,et al., Impaired neurogenic cerebrovascular control and dysautoregulation after stroke. Stroke4 (1973), 169–186.

    PubMed  Google Scholar 

  17. Moore, W. S., Yee, J. M., Hall, A. D., Collateral cerebral blood pressure. Arch. Surg.106 (1973), 520–523.

    Google Scholar 

  18. Nornes, H., Long-term implanted electromagnetic probes in man. New findings in blood flowmetry (Cappelen, C., ed.), pp. 215–219. Oslo: Universitetsforlaget Publ. 1968.

    Google Scholar 

  19. Nornes, H., The role of circle of Willis in graded occlusion of the internal carotid artery in man. Acta neurochir. (Wien)28 (1973), 165–177.

    Google Scholar 

  20. Nornes, H., Grip, A., Hemodynamic aspects of cerebral arteriovenous malformations. J. Neurosurg.53 (1980), 456–464.

    PubMed  Google Scholar 

  21. Patterson, R. H., Risk of carotid surgery with occlusion of the contralateral carotid artery. Arch. Neurol.30 (1974), 188–189.

    PubMed  Google Scholar 

  22. Paulson, O. B., Cerebral apoplexy (stroke): pathogenesis, pathophysiology and therapy as illustrated by regional blood flow measurements in the brain. Stroke2 (1971), 327–360.

    PubMed  Google Scholar 

  23. Phillips, M. R., Johnson, W. C., Scott, R. M.,et al., Carotid endarterectomy in the presence of contralateral carotid occlusion. Arch. Surg.114 (1979), 1232–1238.

    PubMed  Google Scholar 

  24. Piepgras, D. G., Sundt, T. M., Jr., Clinical and laboratory experience with heparin-impregnated silicone shunts for carotid endarterectomy. Ann. Surg.184 (1976), 637–641.

    PubMed  Google Scholar 

  25. Prioleau, W. H., Aiken, A. F., Hairston, P., Carotid endarterectomy. Ann. Surg.115 (1977), 678–681.

    Google Scholar 

  26. Roberts, B., Hardesty, W. H., Holling, H. E.,et al., Studies on extracranial cerebral blood flow. Surg.56 (1964), 826–833.

    Google Scholar 

  27. Samnegård, H., Studies on internal carotid artery blood flow. Scand. J. Thor. Cardiovasc. Surg. Suppl. 13 (1974).

  28. Skinhøj, E., Høedt-Rasmussen, K., Paulson, O. B., Regional cerebral blood flow and its autoregulation in patients with transient focal cerebral ischemic attacks. Neurol. (Minneap.)20 (1970), 485–493.

    Google Scholar 

  29. Spetzler, R. F., Wilson, C. B., Weinstein, P.,et al., Normal perfusion pressure breakthrough theory. Clin. Neurosurg.25 (1978), 651–672.

    PubMed  Google Scholar 

  30. Sundt, T. M., Sharbrough, F. W., Anderson, R. E.,et al., Cerebral blood flow measurements and electroencephalograms during endarterectomy. J. Neurosurg.41 (1974), 310–319.

    PubMed  Google Scholar 

  31. Thompson, J. E., The development of carotid artery surgery. Arch. Surg.107 (1973), 643–649.

    PubMed  Google Scholar 

  32. Whitney, D. G., Kahn, E. M., Estes, J. W., Jones, C. E., Carotid artery surgery without temporary indwelling shunt. Arch. Surg.115 (1980), 1393–1398.

    PubMed  Google Scholar 

Download references

Author information

Author notes

  1. J. Wiberg

    Present address: Department of Neurosurgery, National Hospital Rikshospitalet, Oslo, Norway

Authors and Affiliations

  1. Department of Neurosurgery, National Hospital Rikshospitalet, Oslo, Norway

    H. Nornes

Authors
  1. J. Wiberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. H. Nornes
    View author publications

    You can also search for this author in PubMed Google Scholar

Rights and permissions

Reprints and permissions

About this article

Cite this article

Wiberg, J., Nornes, H. Effects of carotid endarterectomy on blood flow in the internal carotid artery. Acta neurochir 68, 217–226 (1983). https://doi.org/10.1007/BF01401180

Download citation

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF01401180

Keywords

Search

Navigation