(Stroke. 1997;28:1340-1344.)
© 1997 American Heart Association, Inc.
Articles |
Impaired Dynamic Cerebral Autoregulation in Carotid Artery Stenosis
From the Department of Clinical Neurosciences, King's College School of Medicine and Dentistry and the Institute of Psychiatry, London, UK.
Correspondence to Dr Hugh Markus, Department of Clinical Neurosciences, Institute of Psychiatry, De Crespigny Park, London SE5 8AF, UK. E-mail h.markus{at}iop.bpmf.ac.uk
Background and Purpose If it could be determined whether cerebral blood flow can be maintained (autoregulated) during transient falls in arterial blood pressure, we might be able to identify patients with carotid stenosis who are at risk of stroke. However, conventional methods of determining autoregulation in such patients are invasive and/or expensive.
Methods We used a new noninvasive method to estimate dynamic cerebral autoregulation in 27 patients with carotid stenosis and 21 age-matched normal controls. After a stepwise fall in arterial blood pressure, we determined the rate of rise of middle cerebral artery blood flow velocity compared with that of arterial blood pressure. We compared the method with a conventional method of determining cerebral hemodynamics, CO2 reactivity.
Results Autoregulatory index (ARI) was significantly reduced in middle cerebral arteries ipsilateral to a stenosed/occluded carotid artery: mean±SD 3.3±2.2 compared with normal controls (6.3±1.1; P<.0001) and nonstenosed carotid arteries in patients (5.9±2.1; P<.002). A subgroup of patients with severe impairment was identified. ARI returned to normal after carotid endarterectomy was performed. In a number of cases, ARI was impaired in the presence of CO2 reactivity.
Conclusions This simple technique allows identification of impaired autoregulation in patients with carotid artery disease. It may allow identification of patients at risk from transient falls of blood pressure as may occur at the onset of antihypertensive therapy and during surgery. It may allow a subgroup of patients with asymptomatic carotid stenosis who are at risk of hemodynamic stroke to be identified.
Key Words: carotid stenosis • autoregulation • cerebral circulation • ultrasonics
This article has been cited by other articles:
 |
|
 |
|
  M. Czosnyka, P. Smielewski, A. Lavinio, J. D. Pickard, and R. Panerai An Assessment of Dynamic Autoregulation from Spontaneous Fluctuations of Cerebral Blood Flow Velocity: A Comparison of Two Models, Index of Autoregulation and Mean Flow Index Anesth. Analg., January 1, 2008; 106(1): 234 - 239. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. L. Sammons, N. J. Samani, S. M. Smith, W. E. Rathbone, S. Bentley, J. F. Potter, and R. B. Panerai Influence of noninvasive peripheral arterial blood pressure measurements on assessment of dynamic cerebral autoregulation J Appl Physiol, July 1, 2007; 103(1): 369 - 375. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S. J. Howell Carotid endarterectomy Br. J. Anaesth., July 1, 2007; 99(1): 119 - 131. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 Y. Kadoi, S. Saito, N. Fujita, and F. Goto Risk factors for cognitive dysfunction after coronary artery bypass graft surgery in patients with type 2 diabetes J. Thorac. Cardiovasc. Surg., March 1, 2005; 129(3): 576 - 583. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 J. Kolodjaschna, F. Berisha, S. Lung, H. Schima, E. Polska, and L. Schmetterer Comparison of the Autoregulatory Mechanisms between Middle Cerebral Artery and Ophthalmic Artery after Thigh Cuff Deflation in Healthy Subjects Invest. Ophthalmol. Vis. Sci., February 1, 2005; 46(2): 636 - 640. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. M. Serrador, F. A. Sorond, M. Vyas, M. Gagnon, I. D. Iloputaife, and L. A. Lipsitz Cerebral pressure-flow relations in hypertensive elderly humans: transfer gain in different frequency domains J Appl Physiol, January 1, 2005; 98(1): 151 - 159. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Kadoi, S. Saito, F. Goto, and N. Fujita The Effect of Diabetes on the Interrelationship Between Jugular Venous Oxygen Saturation Responsiveness to Phenylephrine Infusion and Cerebrovascular Carbon Dioxide Reactivity Anesth. Analg., August 1, 2004; 99(2): 325 - 331. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Reinhard, M. Roth, T. Muller, B. Guschlbauer, J. Timmer, M. Czosnyka, and A. Hetzel Effect of Carotid Endarterectomy or Stenting on Impairment of Dynamic Cerebral Autoregulation Stroke, June 1, 2004; 35(6): 1381 - 1387. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Sachar, J. S. Yadav, M. Roffi, L. Cho, J. P. Reginelli, A. Abou-Chebl, D. L. Bhatt, and C. T. Bajzer Severe bilateral carotid stenosis: The impact of ipsilateral stenting on Doppler-defined contralateral stenosis J. Am. Coll. Cardiol., April 21, 2004; 43(8): 1358 - 1362. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H S Markus Cerebral perfusion and stroke J. Neurol. Neurosurg. Psychiatry, March 1, 2004; 75(3): 353 - 361. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Neri, C. Sassi, L. Barabesi, M. Massetti, G. Pula, D. Buklas, R. Tassi, and P. Giomarelli Cerebral autoregulation after hypothermic circulatory arrest in operations on the aortic arch Ann. Thorac. Surg., January 1, 2004; 77(1): 72 - 79. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. W. Park, M. Sturzenegger, C. M. Douville, R. Aaslid, and D. W. Newell Autoregulatory Response and CO2 Reactivity of the Basilar Artery Stroke, January 1, 2003; 34(1): 34 - 39. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 L. M. Carusone, J. Srinivasan, D. R. Gitelman, M. M. Mesulam, and T. B. Parrish Hemodynamic Response Changes in Cerebrovascular Disease: Implications for Functional MR Imaging AJNR Am. J. Neuroradiol., August 1, 2002; 23(7): 1222 - 1228. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. H. Danton, R. Prado, B. D. Watson, and W. D. Dietrich Temporal Profile of Enhanced Vulnerability of the Postthrombotic Brain to Secondary Embolic Events Stroke, April 1, 2002; 33(4): 1113 - 1119. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. B. Panerai, S. L. Dawson, P. J. Eames, and J. F. Potter Cerebral blood flow velocity response to induced and spontaneous sudden changes in arterial blood pressure Am J Physiol Heart Circ Physiol, May 1, 2001; 280(5): H2162 - H2174. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
B. J. Carey, P. J. Eames, M. J. Blake, R. B. Panerai, and J. F. Potter Dynamic Cerebral Autoregulation Is Unaffected by Aging Stroke, December 1, 2000; 31(12): 2895 - 2900. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Grubhofer, W. Plochl, M. Skolka, M. Czerny, M. Ehrlich, and A. Lassnigg Comparing Doppler Ultrasonography and Cerebral Oximetry as Indicators for Shunting in Carotid Endarterectomy Anesth. Analg., December 1, 2000; 91(6): 1339 - 1344. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. J. Mahony, R. B. Panerai, S. T. Deverson, P. D. Hayes, and D. H. Evans Assessment of the Thigh Cuff Technique for Measurement of Dynamic Cerebral Autoregulation Stroke, February 1, 2000; 31(2): 476 - 480. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
H. S MARKUS Transcranial Doppler ultrasound J. Neurol. Neurosurg. Psychiatry, August 1, 1999; 67(2): 135 - 137. [Full Text] [PDF]
|
|
|
|
 |
|
 A. Harris, T. A. Ciulla, H. S. Chung, and B. Martin Regulation of Retinal and Optic Nerve Blood Flow Arch Ophthalmol, November 1, 1998; 116(11): 1491 - 1495. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. B. Panerai, R. P. White, H. S. Markus, and D. H. Evans Grading of Cerebral Dynamic Autoregulation From Spontaneous Fluctuations in Arterial Blood Pressure Stroke, November 1, 1998; 29(11): 2341 - 2346. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kluytmans, J. van der Grond, B. C. Eikelboom, and M. A. Viergever Long-Term Hemodynamic Effects of Carotid Endarterectomy Stroke, August 1, 1998; 29(8): 1567 - 1572. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
J. Dumville, R. B. Panerai, N. S. Lennard, A. R. Naylor, and D. H. Evans Can Cerebrovascular Reactivity Be Assessed Without Measuring Blood Pressure in Patients With Carotid Artery Disease? Stroke, May 1, 1998; 29(5): 968 - 974. [Abstract] [Full Text] [PDF]
|
|