Stroke, Vol 23, 668-673, Copyright © 1992 by American Heart Association
HS Markus and MJ Harrison
BACKGROUND AND PURPOSE: A proportion of individuals with carotid artery
stenosis show a reduced cerebrovascular reserve as measured by a reduced
cerebral arterial vasodilatory response to carbon dioxide. Two methods of
quantifying this vasodilatory response, using transcranial Doppler
ultrasonography, have been in general use: the total range of vasodilation
between hypocapnia, induced by hyperventilation, and hypercapnia induced by
breathing carbon dioxide, and the response to breathing a fixed
concentration of 5% carbon dioxide. We studied whether it is possible to
use the rise in carbon dioxide occurring during breath-holding as the
vasodilatory stimulus. METHODS: Using transcranial Doppler, cerebral
reactivity to carbon dioxide was measured in 23 subjects undergoing
intravenous digital subtraction angiography of their carotid arteries for
symptoms of cerebrovascular disease. A breath-holding method was compared
with the two previous methods, which required administration of carbon
dioxide. RESULTS: All three methods gave results that correlated highly
significantly with the degree of carotid stenosis, although the correlation
was highest when the full vasodilatory range was measured. This method was
adopted as the gold standard, and the other methods were compared with it.
The breath-holding method correlated at least as well (rho = 0.67) as the
5% CO2 method (rho = 0.64). It identified a similar group of low reactors
to our gold standard method, whereas the 5% CO2 method gave some discrepant
results. CONCLUSIONS: The breath-holding method offers potential as a
convenient, well-tolerated screening method of assessing carbon dioxide
reactivity not requiring the administration of carbon dioxide, although
further validation against more established methods of measuring
cerebrovascular reserve is first required.
ARTICLES
Estimation of cerebrovascular reactivity using transcranial Doppler, including the use of breath-holding as the vasodilatory stimulus
Department of Neurology, Middlesex Hospital, London, UK.
This article has been cited by other articles:
 |
|
 |
|
  E. Martinez-Fernandez, F. B. Garcia, J.R. Gonzalez-Marcos, A. G. Peralta, A. G. Garcia, and A. M. Deya Clinical and Electroencephalographic Features of Carotid Sinus Syncope Induced by Internal Carotid Artery Angioplasty AJNR Am. J. Neuroradiol., February 1, 2008; 29(2): 269 - 272. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 A. V. Alexandrov, V. K. Sharma, A. Y. Lao, G. Tsivgoulis, M. D. Malkoff, and A. W. Alexandrov Reversed Robin Hood Syndrome in Acute Ischemic Stroke Patients Stroke, November 1, 2007; 38(11): 3045 - 3048. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Uzuner, S. Ozkan, and N. Cinar Cerebrovascular reactivity in multiple sclerosis patients Multiple Sclerosis, July 1, 2007; 13(6): 737 - 741. [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]
|
|
|
|
|
|
M. Silvestrini, P. Pasqualetti, R. Baruffaldi, M. Bartolini, Y. Handouk, M. Matteis, F. Moffa, L. Provinciali, and F. Vernieri Cerebrovascular Reactivity and Cognitive Decline in Patients With Alzheimer Disease Stroke, April 1, 2006; 37(4): 1010 - 1015. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Diomedi, F. Sallustio, B. Rizzato, F. Ferrante, G. Leone, E. Spera, M. Scarfini, and G. Bernardi Sildenafil increases cerebrovascular reactivity: A transcranial Doppler study Neurology, September 27, 2005; 65(6): 919 - 921. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Neri, G. Sani, M. Massetti, G. Frati, D. Buklas, R. Tassi, M. Giubbolini, A. Benvenuti, and C. Sassi Residual dissection of the brachiocephalic arteries: Significance, management, and long-term outcome J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 303 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. de Boorder, J. Hendrikse, and J. van der Grond Phase-Contrast Magnetic Resonance Imaging Measurements of Cerebral Autoregulation With a Breath-Hold Challenge: A Feasibility Study Stroke, June 1, 2004; 35(6): 1350 - 1354. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
V. Novak, A. Chowdhary, B. Farrar, H. Nagaraja, J. Braun, R. Kanard, P. Novak, and A. Slivka Altered cerebral vasoregulation in hypertension and stroke Neurology, May 27, 2003; 60(10): 1657 - 1663. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. Allaryari, G. N. McAbee, L. Mueller, R. White, T. Ben-Hur, R.R. Leker, and E. Linetsky Headache characteristics in patients after migrainous stroke Neurology, February 26, 2002; 58(4): 668 - 669. [Full Text] [PDF]
|
|
|
|
|
|
F. Vernieri, P. Pasqualetti, M. Matteis, F. Passarelli, E. Troisi, P. M. Rossini, C. Caltagirone, and M. Silvestrini Effect of Collateral Blood Flow and Cerebral Vasomotor Reactivity on the Outcome of Carotid Artery Occlusion Stroke, July 1, 2001; 32(7): 1552 - 1558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Apruzzese, M. Silvestrini, R. Floris, F. Vernieri, A. Bozzao, G. Hagberg, C. Caltagirone, S. Masala, and G. Simonetti Cerebral Hemodynamics in Asymptomatic Patients with Internal Carotid Artery Occlusion: A Dynamic Susceptibility Contrast MR and Transcranial Doppler Study AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1062 - 1067. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 D. A. Dulli Subcortical Infarctions, Transcranial Doppler, and Cerebral Vasomotor Reactivity Arch Neurol, April 1, 2001; 58(4): 551 - 552. [Full Text] [PDF]
|
|
|
|
|
|
L. M. Cupini, M. Diomedi, F. Placidi, M. Silvestrini, and P. Giacomini Cerebrovascular Reactivity and Subcortical Infarctions Arch Neurol, April 1, 2001; 58(4): 577 - 581. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 H. Markus and M. Cullinane Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion Brain, March 1, 2001; 124(3): 457 - 467. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Silvestrini, F. Vernieri, P. Pasqualetti, M. Matteis, F. Passarelli, E. Troisi, and C. Caltagirone Impaired Cerebral Vasoreactivity and Risk of Stroke in Patients With Asymptomatic Carotid Artery Stenosis JAMA, April 26, 2000; 283(16): 2122 - 2127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P. M. Rothwell and C. P. Warlow Low Risk of Ischemic Stroke in Patients With Reduced Internal Carotid Artery Lumen Diameter Distal to Severe Symptomatic Carotid Stenosis : Cerebral Protection Due to Low Poststenotic Flow? Stroke, March 1, 2000; 31(3): 622 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 S Cencetti, A Lagi, M Cipriani, L Fattorini, G Bandinelli, and L Bernardi Autonomic control of the cerebral circulation during normal and impaired peripheral circulatory control Heart, September 1, 1999; 82(3): 365 - 372. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Kastrup, T.-Q. Li, G. H. Glover, and M. E. Moseley Cerebral Blood Flow-Related SignalChanges during Breath-Holding AJNR Am. J. Neuroradiol., August 1, 1999; 20(7): 1233 - 1238. [Abstract] [Full Text]
|
|
|
|
|
|
F. Vernieri, P. Pasqualetti, F. Passarelli, P. M. Rossini, and M. Silvestrini Outcome of Carotid Artery Occlusion Is Predicted by Cerebrovascular Reactivity Stroke, March 1, 1999; 30(3): 593 - 598. [Abstract] [Full Text] [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]
|
|
|
|
|
|
M. Silvestrini, L. M. Cupini, F. Placidi, M. Diomedi, and G. Bernardi Bilateral Hemispheric Activation in the Early Recovery of Motor Function After Stroke Stroke, July 1, 1998; 29(7): 1305 - 1310. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Matteis, E. Troisi, B. C. Monaldo, C. Caltagirone, and M. Silvestrini Age and Sex Differences in Cerebral Hemodynamics : A Transcranial Doppler Study Stroke, May 1, 1998; 29(5): 963 - 967. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
G. Buunk, J. G. van der Hoeven, and A. E. Meinders Cerebrovascular Reactivity in Comatose Patients Resuscitated From a Cardiac Arrest Stroke, August 1, 1997; 28(8): 1569 - 1573. [Abstract] [Full Text]
|
|
|
|
|
|
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]
|
|
|
|
|
|
P. Smielewski, M. Czosnyka, J. D. Pickard, and P. Kirkpatrick Clinical Evaluation of Near-Infrared Spectroscopy for Testing Cerebrovascular Reactivity in Patients With Carotid Artery Disease Stroke, February 1, 1997; 28(2): 331 - 338. [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]
|
|
|
|
|
|
F. P. Tiecks, C. Douville, S. Byrd, A. M. Lam, and D. W. Newell Evaluation of Impaired Cerebral Autoregulation by the Valsalva Maneuver Stroke, July 1, 1996; 27(7): 1177 - 1182. [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]
|
|
|
|
 |
|
 M. J. G. Harrison Neurologic Complications of Coronary Artery Bypass Grafting: Diffuse or Focal Ischemia? Ann. Thorac. Surg., May 1, 1995; 59(5): 1356 - 1358. [Abstract] [Full Text]
|
|
|
|
|
|
M. Silvestrini, L. M. Cupini, E. Troisi, M. Matteis, and G. Bernardi Estimation of Cerebrovascular Reactivity in Migraine Without Aura Stroke, January 1, 1995; 26(1): 81 - 83. [Abstract] [Full Text]
|
|
|
|
|
|
M. Muller, M. Voges, U. Piepgras, and K. Schimrigk Assessment of Cerebral Vasomotor Reactivity by Transcranial Doppler Ultrasound and Breath-Holding : A Comparison With Acetazolamide as Vasodilatory Stimulus Stroke, January 1, 1995; 26(1): 96 - 100. [Abstract] [Full Text]
|
|