E-224 Hemodynamic changes and restenosis risk in carotid endarterectomy: the patching dilemma

• Published in: Journal of neurointerventional surgery Vol. 16; no. Suppl 1; pp. A221 - A222
• Main Authors: Abou-Mrad, T, McGuire, L, Marsh, L, Cebral, J, Charbel, F
• Format: Journal Article
• Language: English
• Published: BMA House, Tavistock Square, London, WC1H 9JR BMJ Publishing Group Ltd 01.07.2024; BMJ Publishing Group LTD
• Subjects: Carotid arteries; Hemodynamics; Patients; Shear stress; SNIS 21st annual meeting electronic poster abstracts; Veins & arteries
• DOI: 10.1136/jnis-2024-SNIS.329
• ISSN: 1759-8478

Introduction/PurposeThe utilization of patches in carotid endarterectomy (CEA) for the management of carotid artery stenosis has been a subject of prolonged debate. The existing literature presents conflicting results, with some studies advocating patch use due to reported improved post-operative outcomes, while others report no significant differences in patient outcomes during the post-operative and follow-up periods. This study aims to contribute to this discourse by investigating the hemodynamic changes associated with patch use and their potential correlation with the risk of artery re-stenosis.MethodsA comparative analysis was conducted on two CEA patients: one without a patch with no-restenosis on follow-up, and another with a patch experiencing a stroke 8 years post-CEA due to carotid re-stenosis. Computational flow dynamics were conducted to assess pre- and post-CEA hemodynamics in both cases, using data from MRA, DSA, and NOVA flow reports. The study analysis was performed using patient-specific flow data as well as uniform flow for both patients.ResultsOur findings revealed distinct hemodynamic profiles between the two patients. In both analyses, the patient treated without a patch exhibited coherent blood flow and higher wall shear stress throughout the carotid artery, resembling patterns typically observed in healthy individuals. In contrast, the patient treated with a patch displayed lower wall shear stress in the patch vicinity, a higher oscillatory index, and non-coherent blood flow- indicative of changes associated with atherosclerosis, endothelial dysfunction, and cellular damage. The region between the carotid bulb formed by the patch and the distal healthy artery demonstrated a high gradient of shear stress, posing a risk of potential cell damage, coinciding with the specific site of re-stenosis.ConclusionThe observed hemodynamic alterations suggest that using a patch may not necessarily result in improved flow and more favorable outcomes. Despite the growing literature supporting patch use in reducing post-operative stroke rates, our study sheds light on the hemodynamic implications of this procedure and provides a valuable insight into the ongoing debate surrounding CEA. It also emphasizes the need for further investigations and consideration of alternative factors influencing surgical decisions.Abstract E-224 Figure 1Disclosures T. Abou-Mrad: None. L. McGuire: None. L. Marsh: None. J. Cebral: None. F. Charbel: 2; C; Transonic, Inc.