Altered flow territories after carotid stenting and carotid endarterectomy

Flow territory images of a 56-year-old man before and after carotid angioplasty with stent placement (CAS) of the 90% stenosis in the left internal carotid artery (ICA). When the stenosed left ICA is labeled selectively, the perfusion signal is observed only in the left middle cerebral artery territory. After CAS, the flow territory of the left ICA has extended into the ipsilateral anterior cerebral artery territory. When labeling the right ICA before intervention, the signal is detected in the right middle cerebral artery territory and in both the left and right anterior cerebral artery territories; but after CAS, the flow territory is restricted to the right anterior cerebral artery and middle cerebral artery territories. Before CAS, the territory of the vertebrobasilar arteries (VBA) extends into the middle cerebral artery flow territory ipsilateral to the ICA stenosis, but after intervention the flow territory is restricted to the posterior part of the imaging slices.

a, Flow territory maps of the ipsilateral internal carotid artery (ICA) for all patients (top row) and control subjects (middle row). Colors indicate the percentage of subjects that demonstrated perfusion in that brain region. The bottom row shows differences in flow territories of the ipsilateral ICA between patients and controls. The color bar with logarithmic scale indicates significant P values. b, Flow territory maps of the contralateral ICA for all patients (top row) and control subjects (middle row). The bottom row shows differences in flow territories of the contralateral ICA between patients and controls. c, Flow territory maps of the vertebrobasilar arteries for all patients (top row) and control subjects (middle row). The bottom row shows differences in flow territories of the VBA between patients and controls.

a, Flow territory maps of patients after carotid angioplasty with stenting (CAS) of the ipsilateral internal carotid artery (ICA). b, Flow territory maps of patients after carotid endarterectomy (CEA) of the ipsilateral ICA. Colors indicate the percentage of subjects that demonstrated perfusion in that brain region.

Mean regional cerebral blood flow (rCBF) for the grey matter of the ipsilateral and contralateral hemispheres in patients before and after carotid angioplasty with stenting (CAS) and carotid endarterectomy (CEA) and in control subjects. Data presented as means ± standard deviation.