Cerebral haemodynamic predictors of changes in cerebrovascular reactivity following carotid angioplasty and stenting and their impact on stroke prevention / Islam Ismael Zaid ; Supervised Saher Elsayed Hashem , Ehab Shaker Belal , Montaser Moawad Hegazy

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Islam Ismael Zaid

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TextLanguage: English Publication details: Cairo : Islam Ismael Zaid , 2017Description: 146 P. : charts , facsimiles ; 25cmOther title:

متنبئات الدورة الدموية الدماغية لتغيرات التفاعلية الدموية المخية الالحقة لقسطرة ودعامة الشريان السباتي وأثرها على الوقاية من السكتات الدماغية [Added title page title]

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Dissertation note: Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery Summary: Objective: Is to evaluate the hemodynamic changes in cerebrovascular reactivity (CVR) proven by the breath holding index (BHI) before and after carotid angioplasty and stenting (CAS) in Egyptian patients presented with symptomatic extracranial carotid disease and their impact on stroke prevention. Methods: 35 patients presented with acute stroke/ TIA, with carotid stenosis over 50% have been evaluated for CAS. Transcranial doppler (TCD) was performed few days prior to, and few days after the intervention. Mean flow velocities (MFV) at middle cerebral artery (MCA) ipsi/contralateral stenosis was recorded. CVR through the apnoea test (BHT) was measured, recording an increase in the mean flow velocity and calculating MCA-BHI (breath-holding index) of ipsi and contralateral stenosis. Follow up after six months using modified Rankin score (mRS). Results: MFV in the MCA has significantly increased both ipsilateral to stenosis from 51.29+/-20.89cm/s prior to intervention, to 66.74+/-28.26 cm/s (p<0.01) post-CAS, as well as contralateral to stenosis, from 60.63+/-21.76 before intervention to 72.86+/-31.89 post-intervention (p<0.01). BHI significantly increased ipsilateral from 0.52+/-0.37 to 1.00+/-0.32 (p <0.01) post-intervention, and contralateral from 0.56+/-0.41 before intervention to 0.91+/-0.34 post-intervention (p<0.01). The improvement persisted 3 months after intervention, both ipsi and contralateral to stenosis. mRS improved from 2.91+/-1.04 down to 0.26+/-0.66 after 6 months. Conclusion: CAS produces an early significant increase of MFV and BHI in the ipsilateral and contralateral anterior circulation. This effect is maintained, 3 months later. As a result, CAS produces an improvement of CVR both ipsilateral and contralateral

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Holdings
Item type	Current library	Home library	Call number	Copy number	Status	Date due	Barcode
Thesis	قاعة الرسائل الجامعية - الدور الاول	المكتبة المركزبة الجديدة - جامعة القاهرة	Cai01.11.20.Ph.D.2017.Is.C (Browse shelf(Opens below))		Not for loan		01010110073791000
CD - Rom	مخـــزن الرســائل الجـــامعية - البدروم	المكتبة المركزبة الجديدة - جامعة القاهرة	Cai01.11.20.Ph.D.2017.Is.C (Browse shelf(Opens below))	73791.CD	Not for loan		01020110073791000

Thesis (Ph.D.) - Cairo University - Faculty of Medicine - Department of Neurosurgery

Objective: Is to evaluate the hemodynamic changes in cerebrovascular reactivity (CVR) proven by the breath holding index (BHI) before and after carotid angioplasty and stenting (CAS) in Egyptian patients presented with symptomatic extracranial carotid disease and their impact on stroke prevention. Methods: 35 patients presented with acute stroke/ TIA, with carotid stenosis over 50% have been evaluated for CAS. Transcranial doppler (TCD) was performed few days prior to, and few days after the intervention. Mean flow velocities (MFV) at middle cerebral artery (MCA) ipsi/contralateral stenosis was recorded. CVR through the apnoea test (BHT) was measured, recording an increase in the mean flow velocity and calculating MCA-BHI (breath-holding index) of ipsi and contralateral stenosis. Follow up after six months using modified Rankin score (mRS). Results: MFV in the MCA has significantly increased both ipsilateral to stenosis from 51.29+/-20.89cm/s prior to intervention, to 66.74+/-28.26 cm/s (p<0.01) post-CAS, as well as contralateral to stenosis, from 60.63+/-21.76 before intervention to 72.86+/-31.89 post-intervention (p<0.01). BHI significantly increased ipsilateral from 0.52+/-0.37 to 1.00+/-0.32 (p <0.01) post-intervention, and contralateral from 0.56+/-0.41 before intervention to 0.91+/-0.34 post-intervention (p<0.01). The improvement persisted 3 months after intervention, both ipsi and contralateral to stenosis. mRS improved from 2.91+/-1.04 down to 0.26+/-0.66 after 6 months. Conclusion: CAS produces an early significant increase of MFV and BHI in the ipsilateral and contralateral anterior circulation. This effect is maintained, 3 months later. As a result, CAS produces an improvement of CVR both ipsilateral and contralateral

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