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(Stroke. 1995;26:2293-2297.)
© 1995 American Heart Association, Inc.

Articles

Application of Transcranial Doppler Sonography to Evaluate Cerebral Hemodynamics in Carotid Artery Disease

Comparative Analysis of Different Hemodynamic Variables

Wolfgang H. Hartl, MD Heinrich Fürst, MD

From the Department of Surgery, Klinikum Grosshadern, Ludwig-Maximilian University Munich (Germany).

Correspondence to Heinrich Fürst, MD, Chirurgische Klinik, Klinikum Grosshadern, Marchioninistrasse 15, D-81377 Munich, Germany.

Background and Purpose Transcranial Doppler sonography in combination with manipulation of cerebral resistance vessels is widely used to screen patients with suspected intracranial hemodynamic disturbances. Maximal flow velocity (V_max), mean flow velocity (V_mean), cerebral pulsatility index (CP_i), and cerebral resistance index (CR_i) have all been used to describe cerebral hemodynamics. The present study examined CO₂ reactivity of the above hemodynamic variables with respect to its variability between different age groups and its capability to discriminate between normal and abnormal findings.

Methods Absolute and relative CO₂ reactivity of V_max, V_mean, CR_i, and CP_i were determined in both hemispheres in 30 young and 37 elderly control subjects and in 245 consecutive patients with strictly unilateral symptomatic (n=101) or asymptomatic (n=144) carotid artery disease (>80% stenosis or occlusion).

Results Hemispheric reactivities of V_mean, CR_i, and CP_i were significantly age dependent. Hemispheric V_max reactivity and interhemispheric differences of individual reactivities (except absolute CP_i reactivity) did not vary with age and could therefore be used to define normal values. Patient classification according to these values revealed different frequencies of subjects with pathological findings (3% for hemispheric V_max reactivity, 5% to 7% for interhemispheric differences of V_max or V_mean reactivity, 39% and 45% for interhemispheric differences of relative CR_i and CP_i reactivity, respectively).

Conclusions Hemispheric reactivities are less suitable to evaluate cerebral hemodynamics than interhemispheric differences, since most of the latter do not vary with age. However, interhemispheric differences vary with respect to their discriminatory power. Power is low for interhemispheric differences of V_max and V_mean reactivity, since the corresponding frequencies of abnormal findings do not differ from the 5% frequency expected in the reference population (reference range defined as mean±2 SD). With respect to the discriminatory power, interhemispheric differences of relative CR_i and CP_i reactivity may be superior to other parameters.

Key Words: carotid artery disease • hemodynamics • ultrasonics

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