(Stroke. 1995;26:96-100.)
© 1995 American Heart Association, Inc.
Articles |
Assessment of Cerebral Vasomotor Reactivity by Transcranial Doppler Ultrasound and Breath-Holding
A Comparison With Acetazolamide as Vasodilatory Stimulus
From the Department of Neurology (M.M., K.S.) and Institute of Neuroradiology (M.V., U.P.), University of the Saarland, Homburg/Saar, Germany.
Correspondence to Martin Müller, MD, Nervenklinik, Department of Neurology, University of the Saarland, Oscar-Orth-Str 3, D-66421 Homburg/Saar, Germany.
Background and Purpose Evaluating cerebrovascular vasomotor reactivity seems to be of prognostic relevance for patients with occlusive internal carotid artery disease. To evaluate its clinical usefulness, the recently introduced breath-holding maneuver as a carbon dioxide–dependent vasodilatory stimulus was compared with the acetazolamide challenge by means of transcranial Doppler ultrasound and stable xenon-enhanced computed tomography.
Methods In a total of 134 middle cerebral arteries of 74 patients (mean±SD age, 62±9 years) with unilateral or bilateral occlusive carotid artery disease, vasomotor reactivity was estimated by the increase of middle cerebral artery mean blood velocity by transcranial Doppler ultrasound, comparing the breath-holding maneuver and 1 g IV acetazolamide as vasodilatory stimuli. The carotid artery findings were classified as normal, stenosis of 50% to <70%, 70% to <90%, 90% to 99%, and occlusion. Eighteen of the 74 patients additionally underwent stable xenon-enhanced computed tomography to calculate the increase of mean cortical regional cerebral blood flow in the middle cerebral artery territory after acetazolamide stimulation.
Results The percentage of mean regional cerebral blood flow
changes (n=36 hemispheres) correlated best with the absolute mean
blood velocity changes while breath-holding (P=.007,
r=.4332). The absolute mean regional cerebral blood flow
changes correlated best with the percentage of mean blood velocity
changes after acetazolamide stimulation (P=.004,
r=.4580). On all 134 middle cerebral arteries, both
vasodilatory stimuli correlated highly significantly
(P<.0001) when comparing increases in absolute
(r=.5448) or relative (r=.3516) mean blood
velocity. Both stimulation techniques similarly indicated significantly
reduced vasomotor reactivity with increasing degree of internal carotid
artery lesions (P
.01). However, the acetazolamide
challenge differentiated more accurately between the various groups of
internal carotid artery findings.
Conclusions The assessment of vasomotor reactivity by transcranial Doppler ultrasound correlates with cerebral blood flow changes even when different vasodilatory stimuli are used. In cooperative patients the breath-holding maneuver as vasodilatory stimulus seems clinically useful for a first estimation of cerebral vasomotor reactivity.
Key Words: autoregulation • cerebrovascular disorders • cerebral blood flow • carotid artery diseases • vasomotor reactivity
This article has been cited by other articles:
 |
|
 |
|
  G. S. Sfyroeras, C. D. Karkos, G. Arsos, C. Liasidis, A. S. Dimitriadis, K. O. Papazoglou, and T. S. Gerassimidis Cerebral Hyperperfusion After Carotid Stenting: A Transcranial Doppler and SPECT Study Vascular and Endovascular Surgery, April 1, 2009; 43(2): 150 - 156. [Abstract] [PDF]
|
|
|
|
 |
|
 M. Y. Kassab, A. Majid, M. U. Farooq, H. Azhary, L. A. Hershey, E. M. Bednarczyk, D. F. Graybeal, and M. D. Johnson Transcranial Doppler: An Introduction for Primary Care Physicians J Am Board Fam Med, January 1, 2007; 20(1): 65 - 71. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 I. K. Petropoulos, J.-A. C. Pournaras, J.-L. Munoz, and C. J. Pournaras Effect of Carbogen Breathing and Acetazolamide on Optic Disc PO2 Invest. Ophthalmol. Vis. Sci., November 1, 2005; 46(11): 4139 - 4146. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Muller, O. Bianchi, S. Erulku, C. Stock, and K. Schwerdtfeger Changes in Linear Dynamics of Cerebrovascular System After Severe Traumatic Brain Injury Stroke, May 1, 2003; 34(5): 1197 - 1202. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. F. Soustiel, E. Levy, M. Zaaroor, R. Bibi, S. Lukaschuk, and D. Manor A New Angle-Independent Doppler Ultrasonic Device for Assessment of Blood Flow Volume in the Extracranial Internal Carotid Artery J. Ultrasound Med., December 1, 2002; 21(12): 1405 - 1412. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 T. J. Tegos, E. Kalodiki, S.-S. Daskalopoulou, and A. N. Nicolaides Stroke: Epidemiology, Clinical Picture, and Risk Factors: Part I of III Angiology, October 1, 2000; 51(10): 793 - 808. [Abstract] [PDF]
|
|
|
|
|
|
A. Kastrup, T.-Q. Li, A. Takahashi, G. H. Glover, and M. E. Moseley Functional Magnetic Resonance Imaging of Regional Cerebral Blood Oxygenation Changes During Breath Holding Stroke, December 1, 1998; 29(12): 2641 - 2645. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Dallinger, B. Bobr, O. Findl, H.-G. Eichler, and L. Schmetterer Effects of Acetazolamide on Choroidal Blood Flow Stroke, May 1, 1998; 29(5): 997 - 1001. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. H. Visser, A. C. van Huffelen, G. H. Wieneke, and B. C. Eikelboom Bilateral Increase in CO2 Reactivity After Unilateral Carotid Endarterectomy Stroke, May 1, 1997; 28(5): 899 - 905. [Abstract] [Full Text]
|
|
|
|
|
|
M. Silvestrini, E. Troisi, M. Matteis, L. M. Cupini, and C. Caltagirone Transcranial Doppler Assessment of Cerebrovascular Reactivity in Symptomatic and Asymptomatic Severe Carotid Stenosis Stroke, November 1, 1996; 27(11): 1970 - 1973. [Abstract] [Full Text]
|
|
|
|
|
|
M. Muller and K. Schimrigk Vasomotor Reactivity and Pattern of Collateral Blood Flow in Severe Occlusive Carotid Artery Disease Stroke, February 1, 1996; 27(2): 296 - 299. [Abstract] [Full Text]
|
|