Shen Zi-Duo, Qu Yang, Zhang Peng, Wang Guibin, Wang You, Yang Yi, Xu Baofeng, Guo Zhen-Ni
Stroke Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
Neuroscience Research Center, Department of Neurology, The First Hospital of Jilin University, Changchun, China.
J Endovasc Ther. 2025 Oct;32(5):1267-1274. doi: 10.1177/15266028231213608. Epub 2023 Nov 28.
Studies have shown that dynamic cerebral autoregulation (dCA) is impaired in patients with severe internal carotid artery (ICA) stenosis and that carotid endarterectomy (CEA) may improve dCA in these patients. However, the time course of dCA changes in patients after CEA remains unclear. Therefore, this study aimed to investigate the effects of CEA on the dCA in patients with carotid artery stenosis at different time points.
This prospective study enrolled 44 patients (19 symptomatic stenosis patients and 25 asymptomatic stenosis patients) who underwent CEA and 44 age- and sex-matched controls. In the CEA group, the patients underwent dCA measurements at baseline, within 3 days, and 1 month after CEA. Transfer function parameters, phase difference (PD), and gain were used to quantify dCA. Changes in dCA before and after CEA were analyzed in detail.
The bilateral PD of the patients before CEA was significantly lower than that of the control group. This damage did not improve within 3 days after surgery. One month after surgery, the PD on the affected side of the patients significantly improved compared with before surgery and reached the level of the control group. The PD of affected side across time points in symptomatic and asymptomatic stenosis patients is consistent with that in all patients.
The dCA level did not improve immediately after CEA but significantly improved 1 month after surgery. This suggests that the occurrence of stroke should be considered in the acute period after CEA surgery, and its preventive effect on stroke may be effective after 1 month.Clinical ImpactWe found the dCA level did not improve immediately after CEA but significantly improved 1 month after surgury. This suggests that the occuttencce of stroke and surgical complications (such as cerebral hyperperfusion syndrome) associated with impaired dCA in the acute phase after CEA surgery should be of particular concern.
研究表明，严重颈内动脉（ICA）狭窄患者的动态脑自动调节（dCA）受损，而颈动脉内膜切除术（CEA）可能改善这些患者的dCA。然而，CEA术后患者dCA变化的时间进程仍不清楚。因此，本研究旨在探讨CEA对不同时间点颈动脉狭窄患者dCA的影响。
本前瞻性研究纳入了44例行CEA的患者（19例有症状狭窄患者和25例无症状狭窄患者）以及44例年龄和性别匹配的对照组。在CEA组中，患者在基线、CEA术后3天内和1个月时进行dCA测量。使用传递函数参数、相位差（PD）和增益来量化dCA。详细分析了CEA前后dCA的变化。
CEA术前患者的双侧PD显著低于对照组。术后3天内这种损害没有改善。术后1个月，患者患侧的PD与术前相比显著改善，并达到对照组水平。有症状和无症状狭窄患者患侧PD随时间点的变化与所有患者一致。
CEA术后dCA水平并非立即改善，而是在术后1个月显著改善。这表明在CEA手术后急性期应考虑中风的发生，其对中风的预防作用可能在1个月后有效。
临床影响
我们发现CEA术后dCA水平并非立即改善，而是在术后1个月显著改善。这表明与CEA术后急性期dCA受损相关的中风和手术并发症（如脑过度灌注综合征）的发生应特别关注。
