Published Online
on December 18, 2003

A more recent version of this article appeared on January 1, 2004

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Submitted on September 3, 2003
Accepted on September 12, 2003

Transcranial Doppler and Near-Infrared Spectroscopy Can Evaluate the Hemodynamic Effect of Carotid Artery Occlusion

Fabrizio Vernieri MD^*; Francesco Tibuzzi MD; Patrizio Pasqualetti PhD; Nicola Rosato PhD; Francesco Passarelli MD; Paolo Maria Rossini MD; and Mauro Silvestrini MD

From the AFaR: Dipartimento di Neuroscienze, Ospedale Fatebenefratelli, Isola Tiberina, Roma (F.V., F.T., P.P., N.R., F.P., P.M.R.); Clinica Neurologica, Università Campus Biomedico, Roma (F.V., P.M.R.); Dipartimento di Medicina Sperimentale e Scienze Biochimiche, Università di Roma "Tor Vergata" (N.R.); Clinica Neurologica, Università degli Studi di Ancona (M.S.), Italy.

^* To whom correspondence should be addressed. E-mail: fabriziovernieri{at}tin.it.

Background and Purpose--Cerebral hemodynamic and metabolic changes can compensate for the decrease in cerebral blood flow occurring in patients with carotid occlusive disease. At present, a complete assessment of the cerebral adaptive status is only possible with positron-emission tomography. Near-infrared spectroscopy (NIRS) is a noninvasive technique that, providing a real time assessment of fluctuations in cerebral hemoglobin, has been used to estimate the cerebral blood volume and to measure cerebral vasomotor reactivity (VMR). Moreover, NIRS technology, by allowing the absolute measurement of absorption and scattering coefficients of brain, can determine the oxyhemoglobin and deoxyhemoglobin concentrations in situ in the blood stream.

Methods--In order to evaluate different aspects of the cerebral hemodynamic status, 27 subjects with symptomatic and asymptomatic carotid artery occlusion and 30 healthy subjects underwent a simultaneous examination by means of transcranial Doppler (TCD), able to reliably detect collateral circulation and VMR, and NIRS at rest condition and during CO₂ reactivity test.

Results--The main finding of this study was the demonstration of a difference between asymptomatic and symptomatic patients in terms of mean flow velocity increase (52.4% versus 21.0%; P<0.001) estimated by TCD and of hemoglobin saturation increase measured by NIRS (6.8% versus 3.8%; P=0.015).

Conclusions--The opportunity to perform NIRS and TCD simultaneously provides useful information about both hemodynamic and metabolic cerebral adaptive status in patients with occlusive disease in a simple, noninvasive, and reliable way.

Key words: carotid artery occlusion • hemodynamics • spectroscopy, near-infrared • stroke • ultrasonography, Doppler, transcranial

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