الفهرس Only 14 pages are availabe for public view
 |  | from | 160 |  |  |
| | | from | 160 | | |
Abstract
Objective: Is to evaluate the hemodynamic changes in cerebrovascular reactivity (CVR) proven by the breath holding index (BHI) before and after carotid angioplasty and stenting (CAS) in Egyptian patients presented with symptomatic extracranial carotid disease and their impact on stroke prevention. Methods: 35 patients presented with acute stroke/ TIA, with carotid stenosis over 50% have been evaluated for CAS. Transcranial doppler (TCD) was performed few days prior to, and few days after the intervention. Mean flow velocities (MFV) at middle cerebral artery (MCA) ipsi/contralateral stenosis was recorded. CVR through the apnoea test (BHT) was measured, recording an increase in the mean flow velocity and calculating MCA-BHI (breath-holding index) of ipsi and contralateral stenosis. Follow up after six months using modified Rankin score (mRS). Results: MFV in the MCA has significantly increased both ipsilateral to stenosis from 51.29+/-20.89cm/s prior to intervention, to 66.74+/-28.26 cm/s (p<0.01) post-CAS, as well as contralateral to stenosis, from 60.63+/-21.76 before intervention to 72.86+/-31.89 post-intervention (p<0.01). BHI significantly increased ipsilateral from 0.52+/-0.37 to 1.00+/-0.32 (p <0.01) post-intervention, and contralateral from 0.56+/-0.41 before intervention to 0.91+/-0.34 post-intervention (p<0.01). The improvement persisted 3 months after intervention, both ipsi and contralateral to stenosis. mRS improved from 2.91+/-1.04 down to 0.26+/-0.66 after 6 months. Conclusion: CAS produces an early significant increase of MFV and BHI in the ipsilateral and contralateral anterior circulation. This effect is maintained, 3 months later. As a result, CAS produces an improvement of CVR both ipsilateral and contralateral