{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,4,22]],"date-time":"2026-04-22T20:04:00Z","timestamp":1776888240579,"version":"3.51.2"},"reference-count":40,"publisher":"Journal of Neurosurgery Publishing Group (JNSPG)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JNS"],"published-print":{"date-parts":[[2014,1]]},"abstract":"<jats:sec>\n<jats:title>Object<\/jats:title>\n<jats:p>Transcranial Doppler (TCD) is frequently used to evaluate peripheral cerebral resistance and cerebral blood flow (CBF) in the middle cerebral artery prior to and during carotid endarterectomy (CEA). Patients with symptomatic carotid artery stenosis may have reduced peripheral cerebral resistance to compensate for inadequate CBF. The authors aim to determine whether symptomatic patients with reduced peripheral cerebral resistance prior to CEA demonstrate increased CBF and cognitive improvement as early as 1 day after CEA.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Methods<\/jats:title>\n<jats:p>Fifty-three patients with symptomatic CEA were included in this observational study. All patients underwent neuropsychometric evaluation 24 hours or less preoperatively and 1 day postoperatively. The MCA was evaluated using TCD for CBF mean velocity (MV) and pulsatility index (PI). Pulsatility index \u2264 0.80 was used as a cutoff for reduced peripheral cerebral resistance.<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Results<\/jats:title>\n<jats:p>Significantly more patients with baseline PI \u2264 0.80 exhibited cognitive improvement 1 day after CEA than those with PI &gt; 0.80 (35.0% vs 6.1%, p = 0.007). Patients with cognitive improvement had a significantly greater increase in CBF MV than patients without cognitive improvement (13.4 \u00b1 17.1 cm\/sec vs 4.3 \u00b1 9.9 cm\/sec, p = 0.03). In multivariate regression model, a baseline PI \u2264 0.80 was significantly associated with increased odds of cognitive improvement (OR 7.32 [1.40\u201359.49], p = 0.02).<\/jats:p><\/jats:sec>\n<jats:sec>\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Symptomatic CEA patients with reduced peripheral cerebral resistance, measured as PI \u2264 0.80, are likely to have increased CBF and improved cognitive performance as early as 1 day after CEA for symptomatic carotid artery stenosis. Revascularization in this cohort may afford benefits beyond prevention of future stroke. Clinical trial registration no: NCT00597883 (<jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"ClinicalTrials.gov\" xlink:type=\"simple\">ClinicalTrials.gov<\/jats:ext-link>).<\/jats:p><\/jats:sec>","DOI":"10.3171\/2013.8.jns13931","type":"journal-article","created":{"date-parts":[[2013,9,6]],"date-time":"2013-09-06T13:54:05Z","timestamp":1378475645000},"page":"126-131","source":"Crossref","is-referenced-by-count":22,"title":["Middle cerebral artery pulsatility index and cognitive improvement after carotid endarterectomy for symptomatic stenosis"],"prefix":"10.3171","volume":"120","author":[{"given":"Eric J.","family":"Heyer","sequence":"first","affiliation":[{"name":"Departments of Anesthesiology,"},{"name":"Neurology, and"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Joanna L.","family":"Mergeche","sequence":"additional","affiliation":[{"name":"Departments of Anesthesiology,"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"E. Sander","family":"Connolly","sequence":"additional","affiliation":[{"name":"Neurology, and"},{"name":"Neurological Surgery, Columbia University, New York, New York"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1754","reference":[{"key":"b1-jns13931","series-title":"J Clin Exp Neuropsychol","doi-asserted-by":"publisher","first-page":"785","DOI":"10.1080\/01688639708403760","article-title":"Neuropsychologic effects of carotid endarterectomy","volume":"19","author":"Antonelli Incalzi","year":"1997"},{"key":"b2-jns13931","series-title":"Surgery","doi-asserted-by":"publisher","first-page":"99","DOI":"10.1016\/j.surg.2011.06.031","article-title":"Carotid endarterectomy protects elderly patients from cognitive decline: a prospective study","volume":"151","author":"Baracchini","year":"2012"},{"key":"b3-jns13931","series-title":"N Engl J Med","doi-asserted-by":"publisher","first-page":"1415","DOI":"10.1056\/NEJM199811123392002","article-title":"Benefit of carotid endarterectomy in patients with symptomatic moderate or severe stenosis","volume":"339","author":"Barnett","year":"1998"},{"key":"b4-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"454","DOI":"10.1161\/01.STR.12.4.454","article-title":"Reversal of focal \u201cmisery-perfusion syndrome\u201d by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography","volume":"12","author":"Baron","year":"1981"},{"key":"b5-jns13931","series-title":"Eur J Vasc Endovasc Surg","doi-asserted-by":"publisher","first-page":"83","DOI":"10.1016\/S1078-5884(96)80140-7","article-title":"Use of transcranial Doppler sonography and acetazolamide test to demonstrate changes in cerebrovascular reserve capacity following carotid endarterectomy","volume":"11","author":"Barz\u00f3","year":"1996"},{"key":"b6-jns13931","series-title":"Eur J Vasc Surg","doi-asserted-by":"publisher","first-page":"659","DOI":"10.1016\/S0950-821X(05)80902-8","article-title":"Changes in middle cerebral artery flow velocity and pulsatility index after carotid endarterectomy","volume":"5","author":"Blohm\u00e9","year":"1991"},{"key":"b7-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1122","DOI":"10.1161\/01.STR.25.6.1122","article-title":"Baseline silent cerebral infarction in the Asymptomatic Carotid Atherosclerosis Study","volume":"25","author":"Brott","year":"1994"},{"key":"b8-jns13931","series-title":"J Clin Neurosci","doi-asserted-by":"publisher","first-page":"140","DOI":"10.1054\/jocn.2000.0752","article-title":"Transcranial Doppler in carotid endarterectomy","volume":"8","author":"Dunne","year":"2001"},{"key":"b9-jns13931","series-title":"Eur J Vasc Endovasc Surg","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1016\/S1078-5884(03)00384-8","article-title":"Carotid endarterectomy improves cognitive function in patients with exhausted cerebrovascular reserve","volume":"26","author":"Fearn","year":"2003"},{"key":"b10-jns13931","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"325","DOI":"10.1227\/01.NEU.0000349920.69637.78","article-title":"Incidence of moderate to severe cognitive dysfunction in patients treated with carotid artery stenting","volume":"65","author":"Gaudet","year":"2009"},{"key":"b11-jns13931","series-title":"J Stroke Cerebrovasc Dis","article-title":"The effect of carotid endarterectomy on cerebral blood flow and cognitive function","author":"Ghogawala","year":"2012"},{"key":"b12-jns13931","series-title":"Monaldi Arch Chest Dis","first-page":"91","article-title":"Cognitive changes after carotid endarterectomy","volume":"72","author":"Gremigni","year":"2009"},{"key":"b13-jns13931","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"1491","DOI":"10.1016\/S0140-6736(04)16146-1","article-title":"Prevention of disabling and fatal strokes by successful carotid endarterectomy in patients without recent neurological symptoms: randomised controlled trial","volume":"363","author":"Halliday","year":"2004"},{"key":"b14-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1110","DOI":"10.1161\/01.STR.29.6.1110","article-title":"Neuropsychometric changes in patients after carotid endarterectomy","volume":"29","author":"Heyer","year":"1998"},{"key":"b15-jns13931","series-title":"J Neurosurg Anesthesiol","doi-asserted-by":"publisher","first-page":"324","DOI":"10.1097\/00008506-199610000-00031","article-title":"Psychometric changes in patients having carotid surgery","volume":"8","author":"Heyer","year":"1996"},{"key":"b16-jns13931","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"474","DOI":"10.1227\/01.NEU.0000197123.09972.EA","article-title":"Neuropsychological dysfunction in the absence of structural evidence for cerebral ischemia after uncomplicated carotid endarterectomy","volume":"58","author":"Heyer","year":"2006"},{"key":"b17-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1150","DOI":"10.1161\/STROKEAHA.111.000362","article-title":"Statins reduce neurologic injury in asymptomatic carotid endarterectomy patients","volume":"44","author":"Heyer","year":"2013"},{"key":"b18-jns13931","series-title":"Arch Neurol","doi-asserted-by":"publisher","first-page":"217","DOI":"10.1001\/archneur.59.2.217","article-title":"A controlled prospective study of neuropsychological dysfunction following carotid endarterectomy","volume":"59","author":"Heyer","year":"2002"},{"key":"b19-jns13931","series-title":"J Stroke Cerebrovasc Dis","doi-asserted-by":"publisher","first-page":"234","DOI":"10.1016\/j.jstrokecerebrovasdis.2005.08.001","article-title":"Hemodynamic and metabolic changes after carotid endarterectomy in patients with high-degree carotid artery stenosis","volume":"14","author":"Hino","year":"2005"},{"key":"b20-jns13931","series-title":"Br J Anaesth","doi-asserted-by":"publisher","first-page":"119","DOI":"10.1093\/bja\/aem137","article-title":"Carotid endarterectomy","volume":"99","author":"Howell","year":"2007"},{"key":"b21-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"2084","DOI":"10.1161\/01.STR.28.10.2084","article-title":"Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors","volume":"28","author":"Klijn","year":"1997"},{"key":"b22-jns13931","series-title":"Ultrasound Med Biol","doi-asserted-by":"publisher","first-page":"597","DOI":"10.1016\/S0301-5629(98)00024-6","article-title":"Gosling's Doppler pulsatility index revisited","volume":"24","author":"Michel","year":"1998"},{"key":"b23-jns13931","series-title":"Neurosurgery","doi-asserted-by":"publisher","first-page":"844","DOI":"10.1227\/01.NEU.0000209638.62401.7E","article-title":"Predictors of neurocognitive decline after carotid endarterectomy","volume":"58","author":"Mocco","year":"2006"},{"key":"b24-jns13931","series-title":"Lancet","doi-asserted-by":"publisher","first-page":"857","DOI":"10.1016\/S0140-6736(97)07382-0","article-title":"Long-term postoperative cognitive dysfunction in the elderly ISPOCD1 study. ISPOCD investigators","volume":"351","author":"Moller","year":"1998"},{"key":"b25-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"567","DOI":"10.1161\/01.STR.0000155727.82242.e1","article-title":"The pathophysiology of watershed infarction in internal carotid artery disease: review of cerebral perfusion studies","volume":"36","author":"Momjian-Mayor","year":"2005"},{"key":"b26-jns13931","series-title":"Acta Neurol Scand","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1111\/j.1600-0404.2012.01672.x","article-title":"Diagnosis of and treatment for symptomatic carotid stenosis: an updated review","volume":"126","author":"Momjian-Mayor","year":"2012"},{"key":"b27-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1410","DOI":"10.1161\/STROKEAHA.110.580415","article-title":"Watershed infarcts in transient ischemic attack\/minor stroke with > or = 50% carotid stenosis: hemodynamic or embolic?","volume":"41","author":"Moustafa","year":"2010"},{"key":"b28-jns13931","series-title":"N Engl J Med","doi-asserted-by":"publisher","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"},{"key":"b29-jns13931","series-title":"Eur J Anaesthesiol","doi-asserted-by":"publisher","first-page":"761","DOI":"10.1097\/00003643-199811000-00026","article-title":"Defining postoperative cognitive dysfunction","volume":"15","author":"Rasmussen","year":"1998"},{"key":"b30-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1381","DOI":"10.1161\/01.STR.0000127533.46914.31","article-title":"Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation","volume":"35","author":"Reinhard","year":"2004"},{"key":"b31-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1970","DOI":"10.1161\/01.STR.27.11.1970","article-title":"Transcranial Doppler assessment of cerebrovascular reactivity in symptomatic and asymptomatic severe carotid stenosis","volume":"27","author":"Silvestrini","year":"1996"},{"key":"b32-jns13931","series-title":"Funct Neurol","first-page":"251","article-title":"Cerebral microembolism in atherosclerotic carotid artery disease: facts and perspectives","volume":"10","author":"Sitzer","year":"1995"},{"key":"b33-jns13931","series-title":"Neurology","doi-asserted-by":"publisher","first-page":"1468","DOI":"10.1212\/WNL.62.9.1468","article-title":"Assessment: transcranial Doppler ultrasonography: report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology","volume":"62","author":"Sloan","year":"2004"},{"key":"b34-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1655","DOI":"10.1161\/01.STR.0000075605.36068.D9","article-title":"Cerebral hemodynamics in asymptomatic and symptomatic patients with high-grade carotid stenosis undergoing carotid endarterectomy","volume":"34","author":"Soinne","year":"2003"},{"key":"b35-jns13931","series-title":"Int J Stroke","doi-asserted-by":"publisher","first-page":"97","DOI":"10.1111\/j.1747-4949.2007.00103.x","article-title":"Recent advances in imaging in management of symptomatic internal carotid artery disease","volume":"2","author":"Szabo","year":"2007"},{"key":"b36-jns13931","series-title":"Eur J Vasc Endovasc Surg","doi-asserted-by":"publisher","first-page":"375","DOI":"10.1016\/j.ejvs.2006.04.031","article-title":"Cerebral hemodynamics in symptomatic and asymptomatic patients with severe unilateral carotid stenosis before and after carotid endarterectomy","volume":"32","author":"Telman","year":"2006"},{"key":"b37-jns13931","series-title":"J Vasc Surg","doi-asserted-by":"publisher","first-page":"139","DOI":"10.1067\/mva.2001.109768","article-title":"Flow redistribution in the major cerebral arteries after carotid endarterectomy: a study with transcranial Doppler scan","volume":"33","author":"Vriens","year":"2001"},{"key":"b38-jns13931","series-title":"Stroke","doi-asserted-by":"publisher","first-page":"1340","DOI":"10.1161\/01.STR.28.7.1340","article-title":"Impaired dynamic cerebral autoregulation in carotid artery stenosis","volume":"28","author":"White","year":"1997"},{"key":"b39-jns13931","series-title":"Clin Nucl Med","doi-asserted-by":"publisher","first-page":"128","DOI":"10.1097\/RLU.0b013e31823e9a9a","article-title":"Combination of preoperative cerebral blood flow and 123I-iomazenil SPECT imaging predicts postoperative cognitive improvement in patients undergoing uncomplicated endarterectomy for unilateral carotid stenosis","volume":"37","author":"Yamashita","year":"2012"},{"key":"b40-jns13931","series-title":"Neurol Med Chir (Tokyo)","doi-asserted-by":"publisher","first-page":"154","DOI":"10.2176\/nmc.52.154","article-title":"Improvement and impairment in cognitive function after carotid endarterectomy: comparison of objective and subjective assessments","volume":"52","author":"Yoshida","year":"2012"}],"container-title":["Journal of Neurosurgery"],"original-title":[],"link":[{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/1\/article-p126.xml","content-type":"text\/html","content-version":"vor","intended-application":"text-mining"},{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/1\/article-p126.xml","content-type":"text\/html","content-version":"vor","intended-application":"syndication"},{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/1\/article-p126.xml","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2022,7,24]],"date-time":"2022-07-24T15:13:03Z","timestamp":1658675583000},"score":1,"resource":{"primary":{"URL":"https:\/\/thejns.org\/view\/journals\/j-neurosurg\/120\/1\/article-p126.xml"}},"subtitle":["Clinical article"],"short-title":[],"issued":{"date-parts":[[2014,1]]},"references-count":40,"journal-issue":{"issue":"1"},"URL":"https:\/\/doi.org\/10.3171\/2013.8.jns13931","relation":{},"ISSN":["0022-3085","1933-0693"],"issn-type":[{"value":"0022-3085","type":"print"},{"value":"1933-0693","type":"electronic"}],"subject":[],"published":{"date-parts":[[2014,1]]}}}