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(Stroke. 1997;28:899-905.)
© 1997 American Heart Association, Inc.

Articles

Bilateral Increase in CO₂ Reactivity After Unilateral Carotid Endarterectomy

G. H. Visser, MD; A. C. van Huffelen, MD, PhD; G. H. Wieneke, PhD; B. C. Eikelboom, MD, PhD

From the Department of Clinical Neurophysiology, University Hospital Utrecht and Rudolf Magnus Institute for Neurosciences, Utrecht (G.H.V., A.C. van H., G.H.W.); and the Department of Vascular Surgery, University Hospital Utrecht (B.C.E.), the Netherlands.

Correspondence to G.H. Visser, Department of Clinical Neurophysiology (F.02.230), University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht, PO Box 85500, 3508 GA Utrecht, Netherlands.

Background and Purpose A low or absent CO₂ reactivity is considered indicative of a compromised hemodynamic compensatory capacity in patients with internal carotid artery (ICA) stenosis or occlusion. The aim of the present study was to investigate whether patients with preoperatively decreased or absent CO₂ reactivity show an improvement of CO₂ reactivity 3 months after carotid endarterectomy (CEA) and whether the preoperative CO₂ reactivity is correlated with clinical classification and hemodynamic factors.

Methods A group of 65 patients with >70% ICA stenosis was studied. CO₂ reactivity was measured by bilateral transcranial Doppler sonography before and 3 months after CEA.

Results The preoperative CO₂ reactivity was not significantly different in subgroups formed according to the presenting clinical symptoms. Patients with severe ICA stenosis with contralateral ICA occlusion had mean low preoperative CO₂ reactivity on both sides. Furthermore, patients with reversed flow in the ophthalmic artery had low mean preoperative CO₂ reactivity on the same side. The CO₂ reactivity was not significantly different in the subgroups of patients with signs of collateral blood flow through the anterior or posterior communicating artery. In particular, patients with low preoperative CO₂ reactivity (approximately <30%) showed an evident increase after the operation. Such an inverse correlation was found bilaterally, although it was more pronounced on the CEA side.

Conclusions CEA can increase CO₂ reactivity in both hemispheres. This effect is most pronounced in patients with low (<30%) preoperative CO₂ reactivity. If this group represents patients who would be at risk from low-flow stroke, then testing of CO₂ reactivity might help select a subset of patients with an especially high probability of benefit from CEA.

Key Words: carbon dioxide • carotid endarterectomy • ultrasonics

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