Correlations of Carotid Artery Stenosis and Contralateral Compensatory Mechanisms in Ischemic Stroke Subtypes: hemodynamic analysis

Abstract

Background: Carotid artery stenosis significantly affects the risk of IS by affecting cerebral blood flow. Narrowing of the carotid arteries may lead to decreased perfusion of the brain, which may provoke neurological deficits. Moreover, the body may activate compensatory mechanisms to maintain adequate cerebral blood flow despite significant narrowing of the arteries. Understanding the relationship between carotid artery stenosis and cerebral blood flow velocity is important for effective clinical decision making and patient management. Material and methods: We collected clinical and instrumental data from patients with IS admitted clinic over a period of 1 year (n=240). All patients included in the study underwent ultrasound duplex scanning of the carotid arteries and spine (mean age 62.3±11.2 years), which was performed during their stay in the intensive care unit of neurology. All patients underwent NIHSS and mRankin score, computed tomography and ultrasound examination of the carotid arteries. Carotid plaques were defined by the presence of intimal thickening ≥1 mm. The severity of carotid stenosis was assessed using the NASCET method 1st day of hospitalization. NIHSS and mRankin scales were estimated first, third, seventh and 12 days. Results: There were no significant differences between the 2 groups in terms of clinical characteristics of the patients included in the study. The average clinical score in patients with two subtypes of IS first day of hospitalization was 17.8±3.2 on the NIHSS scale and 4,5±0,5 on the modified Rankin scale, which corresponds to moderate to se vere level of the disease. The mRankin scale and NIHSS scale showed similar results that, in patients with signifi- cant atherosclerotic stenosis, the highest score were revealed in high degree carotid stenosis groups. Although there was a positive change in the indicators over time, in patients with significant stenosis these figures remained high even after 12 days of analysis and it should be noted that the difference between the groups was very notable. Conclusion: According to our study, patients with carotid artery stenosis that is not hemodynamically significant have a more positive prognosis. However, even with standard treatment, patients with high carotid artery stenosis have a recovery process that is as dynamically significant as those with hemodynamically insignificant stenosis. This study highlights the complex relationship between carotid artery stenosis and cerebral hemodynamics, which has important implications for the management and treatment of these patients.