Lu Changyu, Zhu Chenyu, Li Wenjie, Zhu Huan, Zhang Qihang, Liu Tong, Yang Tongyu, Zhang Yan
Department of Neurosurgery, Peking University International Hospital, Beijing, China.
China National Clinical Research Center for Neurological Diseases, Beijing, China.
Chin Neurosurg J. 2025 Jun 17;11(1):12. doi: 10.1186/s41016-025-00398-3.
The increased permeability of the blood-brain barrier (BBB) is related to the occurrence and development of diseases such as acute ischemic stroke, chronic ischemia, or small vessel disease. Patients with carotid artery stenosis have chronic ischemia. The exact effect of carotid endarterectomy on the blood-brain barrier is still unclear. The aim of the study was to assess the effect of carotid endarterectomy on basic perfusion parameters and permeability surface area-product (PS).
The study included a total of 17 subjects (13 men), of which bilateral carotid artery stenosis was greater than 70%. All patients underwent unilateral carotid endarterectomy. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after operation: cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP), and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material.
Before surgery, the operative side exhibited significantly lower CBF (p = 0.001) and prolonged MTT (p = 0.002) and TTP (p = 0.001) compared to the nonoperative side, while PS and CBV showed no significant differences. After carotid endarterectomy, only the operative side demonstrated improvements, with CBV increasing by 9.4%, MTT decreasing by 20.3%, TTP decreasing by 14.1%, and PS decreasing by 27.5% (all p < 0.01). No significant changes were observed on the nonoperative side.
Carotid endarterectomy augmented BBB permeability can be controlled by carotid endarterectomy in patients with carotid artery stenosis.
血脑屏障（BBB）通透性增加与急性缺血性卒中、慢性缺血或小血管疾病等疾病的发生和发展相关。颈动脉狭窄患者存在慢性缺血。颈动脉内膜切除术对血脑屏障的确切影响尚不清楚。本研究的目的是评估颈动脉内膜切除术对基础灌注参数和通透表面积乘积（PS）的影响。
本研究共纳入17名受试者（13名男性），其双侧颈动脉狭窄均大于70%。所有患者均接受了单侧颈动脉内膜切除术。比较手术前后以下计算机断层扫描灌注（CTP）参数的差异：脑血流量（CBF）、脑血容量（CBV）、平均通过时间（MTT）、达峰时间（TTP）和PS。通过CTP获得的PS用于测量血脑屏障对造影剂的通透性。
术前，与非手术侧相比，手术侧的CBF显著降低（p = 0.001），MTT和TTP延长（p = 0.002和p = 0.001），而PS和CBV无显著差异。颈动脉内膜切除术后，仅手术侧有改善，CBV增加9.4%，MTT降低20.3%，TTP降低14.1%，PS降低27.5%（均p < 0.01）。非手术侧未观察到显著变化。
颈动脉内膜切除术可控制颈动脉狭窄患者血脑屏障通透性的增加。
