Evaluating middle cerebral artery collateral blood flow reserve using acetazolamide transcranial Doppler ultrasound in patients with carotid occlusive disease

Transcranial Doppler ultrasound is a relatively new diagnostic modality which allows the non-invasive assessment of intracranial circulation. A total of 10 migraine patients were studied and compared to healthy controls without headaches. Migraineurs during the headache-free interval demonstrated excessive cerebrovascular reactivity to CO2, evidenced by an increase in middle cerebral artery blood flow velocity of 47% ± 15% compared to 28% ± 14% in controls ( p = 0.026). Differences between the two study groups revealed no significant decrease in middle cerebral artery blood flow velocity with hypocapnia. However, the differences between middle cerebral artery blood flow velocity during hyperventilation and CO2 inhalation were significantly different ( p = 0.004) comparing migraineurs and controls. Instability of the baseline blood flow velocities was also noted in migraineurs during the interictal period. Characteristics which may allow differentiation of migraineurs from other headache populations could possibly be obtained from transcranial Doppler ultrasound flow studies.

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Imaging transcranial Doppler ultrasound to measure middle cerebral artery blood flow: the importance of measuring vessel diameter

AJP Regulatory Integrative and Comparative Physiology ◽

10.1152/ajpregu.00025.2020 ◽

2020 ◽

Vol 319 (1) ◽

pp. R33-R42

Author(s):

Catherine L. Jarrett ◽

Katherine L. Shields ◽

Ryan M. Broxterman ◽

Jay R. Hydren ◽

Soung Hun Park ◽

...

Keyword(s):

Blood Flow ◽

Middle Cerebral Artery ◽

Doppler Ultrasound ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Transcranial Doppler Ultrasound ◽

Vessel Diameter ◽

Blood Velocity ◽

Color Flow ◽

Novel Approach

Cerebral blood flow (CBF) is commonly inferred from blood velocity measurements in the middle cerebral artery (MCA), using nonimaging, transcranial Doppler ultrasound (TCD). However, both blood velocity and vessel diameter are critical components required to accurately determine blood flow, and there is mounting evidence that the MCA is vasoactive. Therefore, the aim of this study was to employ imaging TCD (ITCD), utilizing color flow images and pulse wave velocity, as a novel approach to measure both MCA diameter and blood velocity to accurately quantify changes in MCA blood flow. ITCD was performed at rest in 13 healthy participants (7 men/6 women; 28 ± 5 yr) with pharmaceutically induced vasodilation [nitroglycerin (NTG), 0.8 mg] and without (CON). Measurements were taken for 2 min before and for 5 min following NTG or sham delivery (CON). There was more than a fivefold, significant, fall in MCA blood velocity in response to NTG (∆−4.95 ± 4.6 cm/s) compared to negligible fluctuation in CON (∆−0.88 ± 4.7 cm/s) ( P < 0.001). MCA diameter increased significantly in response to NTG (∆0.09 ± 0.04 cm) compared with the basal variation in CON (∆0.00 ± 0.04 cm) ( P = 0.018). Interestingly, the product of the NTG-induced fall in MCA blood velocity and increase in diameter was a significant increase in MCA blood flow following NTG (∆144 ± 159 ml/min) compared with CON (∆−5 ± 130 ml/min) ( P = 0.005). These juxtaposed findings highlight the importance of measuring both MCA blood velocity and diameter when assessing CBF and document ITCD as a novel approach to achieve this goal.

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Technical and anatomical background of four-gate microembolus detection in the middle cerebral artery by transcranial Doppler ultrasound T. Hansberg1, D.W. Droste1, M. Ritter1, S. Hermes1, D. Hammel2, V. Kem�ny1, G. Schulte-Altedorneburg1, D.G. Nabavi1, Hans H. Scheld2, E.B. Ringelstein1. 1Department of Neurology; 2Department of Thoracic and Cardiovascular Surgery, University of M�nster, Germany

European Journal of Ultrasound ◽

10.1016/s0929-8266(97)90101-4 ◽

1997 ◽

Vol 5 ◽

pp. 42

Keyword(s):

Middle Cerebral Artery ◽

Doppler Ultrasound ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Cardiovascular Surgery ◽

Transcranial Doppler Ultrasound

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Cluster Headache: Transcranial Doppler Ultrasound and rCBF Studies

Cephalalgia ◽

10.1046/j.1468-2982.1990.1002087.x ◽

1990 ◽

Vol 10 (2) ◽

pp. 87-94 ◽

Cited By ~ 51

Author(s):

Arve Dahl ◽

David Russell ◽

Rolf Nyberg-Hansen ◽

Kjell Rootwelt

Keyword(s):

Blood Flow ◽

Cluster Headache ◽

Glyceryl Trinitrate ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Statistical Significance ◽

Transcranial Doppler Ultrasound ◽

Normal Limits ◽

Symptomatic Side

Transcranial Doppler and rCBF examinations were carried out in 25 cluster headache patients. Spontaneous and glyceryl trinitrate (nitroglycerin) provoked attacks were accompanied by a bilateral decrease in middle cerebral artery blood flow velocities. This decrease was more pronounced on the symptomatic side but the difference did not reach statistical significance. Mean hemispheric blood flow and rCBF were within normal limits during provoked attacks and similar to those found when patients were attack-free. During cluster periods middle cerebral artery velocities were significantly higher on the symptomatic side. Glyceryl trinitrate caused a bilateral middle cerebral artery velocity decrease which was significantly greater on the symptomatic side. Attacks provoked by glyceryl trinitrate appeared to begin when the vasodilatory effect of this substance was receding.

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Reproducibility of Transcranial Doppler ultrasound in the middle cerebral artery

Cardiovascular Ultrasound ◽

10.1186/s12947-018-0133-z ◽

2018 ◽

Vol 16 (1) ◽

Cited By ~ 5

Author(s):

Jakub Kaczynski ◽

Rachel Home ◽

Karen Shields ◽

Matthew Walters ◽

William Whiteley ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Doppler Ultrasound ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Transcranial Doppler Ultrasound

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Predictability of Cerebral Embolization from Aortic Arch Manipulations During Thoracic Endovascular Repair

The American Surgeon ◽

10.1177/000313481107701029 ◽

2011 ◽

Vol 77 (10) ◽

pp. 1399-1402 ◽

Cited By ~ 6

Author(s):

Karen Kim ◽

Tyler Reynolds ◽

Carlos Donayre ◽

George Kopchok ◽

Rodney White ◽

...

Keyword(s):

Middle Cerebral Artery ◽

Aortic Arch ◽

Doppler Ultrasound ◽

Cerebral Artery ◽

Transcranial Doppler ◽

Transcranial Doppler Ultrasound ◽

Thoracic Endovascular Aortic Repair ◽

Endovascular Aortic Repair ◽

Left Middle Cerebral Artery ◽

Aortic Repair

There is no sensitive tool to monitor embolic events and predict patients at a risk for strokes during thoracic endovascular aortic repair. We examined the relationship between the number of high intensity transient signals (HITS) by transcranial doppler ultrasound and the extent of atherosclerotic plaques in aortic arch. Thirteen patients were treated as a part of a single center United States Food and Drug Administration-approved investigational device exemption for various thoracic aortic pathologies. Bilateral transcranial doppler ultrasound transducers recorded the number of HITS. CT angiography and intravascular ultrasound were used to measure the thickness of mural thrombi and determine their arch location. All 13 patients had detectable HITS, and one patient sustained a stroke. Eleven patients had quantifiable mural thrombi. The highest HITS were observed in patients with thrombi in zones 2 to 3. All three patients with bovine arch had more HITS in the right middle cerebral artery whereas the patients with normal arch anatomy had more HITS in the left middle cerebral artery. The presence of mural thrombi in zones 2 and 3, irrespective of their thickness, was associated with increased HITS during thoracic endovascular aortic repair. This is the first study to characterize the significance of mural thrombi in aortic arch and their relationship to embolic events during aortic arch manipulations.

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