{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,22]],"date-time":"2026-03-22T18:55:20Z","timestamp":1774205720371,"version":"3.50.1"},"reference-count":7,"publisher":"Oxford University Press (OUP)","issue":"2","license":[{"start":{"date-parts":[[1993,2,1]],"date-time":"1993-02-01T00:00:00Z","timestamp":728524800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[1993,2,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:p>The importance of the patency of the contralateral carotid artery on the haemodynamic effect of a carotid stenosis was investigated. The breath-holding index was used to estimate cerebral perfusion reserve. The percentage rise in middle cerebral blood flow velocity, measured by transcranial Doppler ultrasonography, occurring during breath-holding was divided by the time of breath-holding. In study 1, ten subjects with no carotid stenosis, 13 with unilateral and eight with bilateral stenosis were studied. For unilateral stenosis the breath-holding index was reduced on the stenosed side compared with normal (0\u00b785 versus 1\u00b734 per cent per s, P &amp;lt;0\u00b705). For bilateral disease, in the presence of severe stenosis on the side contralateral to that being examined, even a moderate stenosis (30\u201350 per cent) resulted in a much greater reduction in the breath-holding index. In study 2, the breath-holding index was measured before and after carotid endarterectomy in ten patients. The index increased significantly following operation, not only on the operated side (1\u00b731 versus 0\u00b779 per cent per s, P &amp;lt;0\u00b701), but also on the contralateral side (1\u00b723 versus 0\u00b787 per cent per s, P &amp;lt;0\u00b705). In three of four patients with contralateral stenosis &amp;gt;90 per cent or occlusion, operation improved the breath-holding index markedly (&amp;gt;90 per cent) on the non-operated side above the stenosis or occlusion. These results demonstrate the importance of patency of the contralateral carotid artery in determining the haemodynamic effect of a carotid stenosis. In addition, operating contralateral to an occlusion may improve haemodynamic status above the occlusion. Implications in selecting patients for carotid endarterectomy are discussed.<\/jats:p>","DOI":"10.1002\/bjs.1800800212","type":"journal-article","created":{"date-parts":[[2007,3,3]],"date-time":"2007-03-03T18:17:49Z","timestamp":1172945869000},"page":"170-172","source":"Crossref","is-referenced-by-count":23,"title":["Carotid endarterectomy improves haemodynamics on the contralateral side: implications for operating contralateral to an occluded carotid artery"],"prefix":"10.1093","volume":"80","author":[{"given":"H S","family":"Markus","sequence":"first","affiliation":[{"name":"Department of Neurology, University College and Middlesex School of Medicine , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M J","family":"Harrison","sequence":"additional","affiliation":[{"name":"Department of Neurology, University College and Middlesex School of Medicine , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"M","family":"Adiseshiah","sequence":"additional","affiliation":[{"name":"Department of Surgery, University College and Middlesex School of Medicine , London,","place":["UK"]}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"286","published-online":{"date-parts":[[1993,2,1]]},"reference":[{"key":"2024092811473198800_bib1","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1056\/NEJM199108153250701","article-title":"Beneficial effect of carotid endarterectomy in symptomatic patients with high grade carotid stenosis","volume":"325","author":"North American Symptomatic Carotid Endarterectomy Trial Collaborators","year":"1991","journal-title":"N Engl J Med"},{"key":"2024092811473198800_bib2","doi-asserted-by":"crossref","first-page":"1235","DOI":"10.1016\/0140-6736(91)92916-P","article-title":"MRC European Carotid Surgery Trial: interim results for symptomatic patients with severe (70\u201399%) or with mild (0\u201329%) carotid stenosis","volume":"337","author":"European Carotid Surgery Trialists Collaborative Group","year":"1991","journal-title":"Lancet"},{"key":"2024092811473198800_bib3","doi-asserted-by":"crossref","first-page":"899","DOI":"10.1136\/jnnp.49.8.899","article-title":"Reactivity of the cerebral circulation in patients with carotid occlusion","volume":"49","author":"Brown","year":"1986","journal-title":"J Neurol Neurosurg Psychiatry"},{"key":"2024092811473198800_bib4","doi-asserted-by":"crossref","first-page":"913","DOI":"10.1161\/01.STR.17.5.913","article-title":"Transcranial Doppler measurement of middle cerebral artery blood flow velocity: a validation study","volume":"17","author":"Bishop","year":"1986","journal-title":"Stroke"},{"key":"2024092811473198800_bib5","doi-asserted-by":"crossref","first-page":"668","DOI":"10.1161\/01.STR.23.5.668","article-title":"Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus","volume":"23","author":"Markus","year":"1992","journal-title":"Stroke"},{"key":"2024092811473198800_bib6","first-page":"506","article-title":"Cerebral blood flow and CO2 reactivity before and after carotid endarterectomy","volume":"60","author":"Takagi","year":"1979","journal-title":"Acta Neurol Scand"},{"key":"2024092811473198800_bib7","doi-asserted-by":"crossref","first-page":"171","DOI":"10.1161\/01.STR.23.2.171","article-title":"Course of carotid artery occlusions with impaired cerebrovascular reactivity","volume":"23","author":"Kleiser","year":"1992","journal-title":"Stroke"}],"container-title":["Journal of British Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/api.wiley.com\/onlinelibrary\/tdm\/v1\/articles\/10.1002%2Fbjs.1800800212","content-type":"unspecified","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/80\/2\/170\/59398831\/bjs1800800212.pdf","content-type":"application\/pdf","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/academic.oup.com\/bjs\/article-pdf\/80\/2\/170\/59398831\/bjs1800800212.pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,9,28]],"date-time":"2024-09-28T11:47:40Z","timestamp":1727524060000},"score":1,"resource":{"primary":{"URL":"https:\/\/academic.oup.com\/bjs\/article\/80\/2\/170\/6175496"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[1993,2,1]]},"references-count":7,"journal-issue":{"issue":"2","published-online":{"date-parts":[[1993,2,1]]},"published-print":{"date-parts":[[1993,2,1]]}},"URL":"https:\/\/doi.org\/10.1002\/bjs.1800800212","relation":{},"ISSN":["0007-1323","1365-2168"],"issn-type":[{"value":"0007-1323","type":"print"},{"value":"1365-2168","type":"electronic"}],"subject":[],"published-other":{"date-parts":[[1993,2]]},"published":{"date-parts":[[1993,2,1]]}}}