Re-establishment of Cerebral Metabolism After Carotid Endarterectomy

Eur J Vasc Endovasc Surg. 1995 Aug;10(2):182-6. doi: 10.1016/s1078-5884(05)80109-1.


Objectives: The purpose of this study was to evaluate the metabolic changes that occur in the human brain in patients with a symptomatic carotid artery stenosis.

Materials and methods: N-acetyl-aspartate (NAA), choline, creatine and lactate were measured both before, and 4 days after, carotid endarterectomy, by magnetic resonance spectroscopic imaging (MRSI). Eight controls and 16 patients were examined. MRI and MRSI studies were performed on a Philips Gyroscan S15 whole body system operating at 1.5 Tesla. 1H spectra were selected from regions in the centrum semi-ovale outside areas showing white matter hyper intensities on MRI.

Results: All patients showed a decrease of the NAA/choline and NAA/creatine ratio in the symptomatic hemisphere compared to the contralateral hemisphere and also compared to the controls. Lactate was present in some patients (5/16). After endarterectomy, the NAA/choline and NAA/creatine ratios increased significantly compared to the ratios preoperative. Lactate was absent or more than 50% reduced after the operation. MRSI showed metabolic changes in areas of the brain that did not show any abnormalities on MRI.

Conclusions: There are marked changes in brain metabolism in the symptomatic hemisphere of patients with a severe carotid artery stenosis. These metabolic changes normalise four days after endarterectomy.

MeSH terms

  • Aged
  • Aspartic Acid / analogs & derivatives
  • Aspartic Acid / metabolism
  • Brain / metabolism*
  • Choline / metabolism
  • Creatine / metabolism
  • Endarterectomy, Carotid*
  • Female
  • Humans
  • Lactates / metabolism
  • Lactic Acid
  • Magnetic Resonance Imaging
  • Magnetic Resonance Spectroscopy
  • Male
  • Middle Aged


  • Lactates
  • Aspartic Acid
  • Lactic Acid
  • N-acetylaspartate
  • Creatine
  • Choline