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Significance of transcranial doppler CO2 reactivity measurements for the diagnosis of hemodynamically relevant carotid obstructions

  • Original Articles
  • Published:
Annals of Vascular Surgery

Abstract

Transcranial Doppler ultrasonography can be used to determine CO2 reactivity in the large basal cerebral arteries. CO2 reactivity is expressed as percentage increase of mean flow velocity above one volume percent of CO2, using a reference value of 40 mmHg pCO2 normalized autoregulatory reserve. A normalized autoregulatory value of 15 as the lower limit of the normal range clearly separates patients with internal carotid artery obstructions ≥ 70% from the control group. Stenoses of the ipsilateral internal carotid artery of ≥ 70% result in a significant decrease of normalized autoregulatory reserve in the middle cerebral artery, which can be normalized by removal of the upstream flow obstacle using a carotid thromboendarterectomy. The scatter of normalized autoregulatory values in severe internal carotid obstructions indicates the variability of collateral circulation. A retrospective comparison of normalized autoregulatory reserve and ipsilateral ischemic symptoms in the supply area of the internal carotid artery reveals a significant correlation between clinical symptoms and reduced normalized autoregulatory reserve.

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References

  1. CAPLAN LR, SERGAY S. Positional cerebral ischemia.J Neurol Neurosurg Psychiatry 1976;39:385–391.

    PubMed  CAS  Google Scholar 

  2. CARTER JE. Chronic ocular ischemia and carotid vascular disease.Stroke 1985;16:721–728.

    PubMed  CAS  Google Scholar 

  3. ZEUMER H, RINGELSTEIN EB. Computed tomography patterns of brain infarctions as a pathogenetic key. In: POECK K, RINGELSTEIN EB, HACKE W, (eds). New trends in diagnosis and management of stroke. Berlin, Heidelberg, New York: Springer 1987, pp 75–85.

    Google Scholar 

  4. BROWN MM, WADE JPH, BISHOP CCR, et al. Reactivity of the cerebral circulation in patients with carotid occlusion.J Neurol Neurosurg Psych 1986;49:899–904.

    CAS  Google Scholar 

  5. HARPER AM, GLASS HI. Effect of alterations in the arterial carbon dioxide tension on the blood flow through the cerebral cortex at normal and low arterial pressures.J Neurol Neurosurg Psych 1965;28:449.

    PubMed  CAS  Google Scholar 

  6. GIBBS JM, WISE RJS, LEENDERS KL, et al. Evaluation of cerebral perfusion reserve in patients with carotid artery occlusion.Lancet 1984;1:310–314.

    PubMed  CAS  Google Scholar 

  7. BLOOR BM, ASLI RP, NUGENT GR, et al. Relationship of cerebrovascular reactivity to degree of extracranial vascular occlusion.Circulation 1966;28 (Suppl. II):33–34.

    Google Scholar 

  8. INGVAR DH, LASSEN NA. Regional blood flow of the cerebral cortex determined by 85-Krypton.Acta Physiol Scand 1961;54:325.

    Article  Google Scholar 

  9. GUR D, WOLFSON SK, YONAS H, et al. Progress in cerebrovascular disease: local cerebral blood flow by xenon enhanced CT.Stroke 1982;13:750–759.

    PubMed  CAS  Google Scholar 

  10. AASLID R, MARKWALDER TM, NORNES H. Noninvasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries.J Neurosurg 1982;57:769–774.

    Article  PubMed  CAS  Google Scholar 

  11. HUBER P, HANDA J. Effect of contrast material, hypercapnia, hyperventilation, hypertonic glucose and papaverine on the diameter of the cerebral arteries—angiographic determination in man.Invest Radiol 1967;2:17–32.

    PubMed  CAS  Google Scholar 

  12. RINGELSTEIN EB, GROSSE W, MATENZOGLU S, et al. Noninvasive assessment of the cerebral vasomotor reactivity by means of transcranial Doppler sonography during hyper- and hypocapnea.Klin Wochenschr 1986;64:194–195.

    Article  PubMed  CAS  Google Scholar 

  13. BISHOP CCR, POWELL S, RUTT D, et al. Transcranial doppler measurement of middle cerebral artery blood flow velocity: a validation study.Stroke 1986;17:913–915.

    PubMed  CAS  Google Scholar 

  14. HEROLD S, BROWN MM, FRACHOWIAK RSJ, et al. Assessment of cerebral haemodynamic reserve: correlation between Pet-parameters and CO-reactivity measured by the intravenous 133 Xenon injection technique.J Neurol Neurosurg Psych 1988;51:1045–1050.

    Article  PubMed  CAS  Google Scholar 

  15. EC-IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke: results of an international randomized trial.N Engl J Med 1985;1191–1200.

  16. WIDDER B, PAULAT K, HACKSPACHER J, et al. Transcranial Doppler CO-test for the detection of hemodynamically critical carotid artery stenoses and occlusions.Eur Arch Psych Neurol Sci 1986;236:162–168.

    Article  CAS  Google Scholar 

  17. WIDDER B. The Doppler CO-test to exclude patients not in need of extracranial/intracranial bypass surgery.J Neurol Neurosurg Psychiatry 1989;52:38–42.

    PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. From the Departments of Clinical Neurophysiology, Vascular and Chest Surgery, Zentralklinikum Augsburg, Augsburg, West Germany

    W. Reith, K. Pfadenhauer &  H. Loeprecht

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  1. W. Reith
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  2. K. Pfadenhauer
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  3. H. Loeprecht
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Reith, W., Pfadenhauer, K. & Loeprecht, H. Significance of transcranial doppler CO2 reactivity measurements for the diagnosis of hemodynamically relevant carotid obstructions. Annals of Vascular Surgery 4, 359–364 (1990). https://doi.org/10.1007/BF02000500

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  • DOI: https://doi.org/10.1007/BF02000500

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