Cerebrovascular Carbon Dioxide Reactivity in Carotid Artery Disease 

1995 ◽  
Vol 82 (3) ◽  
pp. 655-661 ◽  
Author(s):  
A. Thiel ◽  
B. Zickmann ◽  
W. A. Stertmann ◽  
T. Wyderka ◽  
G. Hempelmann
Keyword(s):  
Carbon Dioxide ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Transcranial Doppler Sonography ◽  
Cerebrovascular Reactivity ◽  
Conduction Time ◽  
Exact Test ◽  
Increased Risk ◽  
Artery Disease ◽  
Carbon Dioxide Reactivity

Background In patients with carotid artery disease, poor intracerebral collateralization is reflected by impaired cerebrovascular reactivity to carbon dioxide inhalation, which will improve after endarterectomy. The relationship between preoperative reactivity to carbon dioxide using transcranial Doppler sonography (TCD) and intraoperative changes of somatosensory evoked potentials (SEP) and TCD parameters were investigated. Methods In 94 patients, preoperative carbon dioxide reactivity was examined and defined impaired if mean blood flow velocity in the middle cerebral artery (Vm-MCA) increased less than 1.5% mmHg during carbon dioxide challenge. Patients then underwent 100 carotid operations under general anesthesia with both SEP and TCD monitoring. Shunts were placed if SEP amplitude decreased to less then 50% of control or central conduction time increased by 20% after clamping (critical SEP changes). TCD changes were defined as critical in case of a postclamping/preclamping Vm-MCA ratio < or = 0.4. The incidence of critical SEP and TCD changes was compared to preoperative carbon dioxide testing using Fisher's exact test with P < 0.05 considered significant. Postoperatively, neurologic state and carbon dioxide responsiveness were re-examined. Results Twelve patients showed impaired preoperative carbon dioxide reactivity on the side of operation, which improved markedly after surgery. The incidence of critical SEP changes in these cases (8.3%) was not significantly different from that in the remaining patients (14.8%). Critical SEP changes were significantly correlated with critical TCD changes (P < 0.0001). Conclusions Patients with poor carbon dioxide reactivity (preoperative TCD testing) did not have an increased risk of cerebral ischemia during carotid surgery, as assessed by intraoperative SEP recording.

Cerebrovascular Carbon Dioxide Reactivity in Carotid Artery Disease

1996 ◽  
Vol 40 (2) ◽  
pp. 85
Author(s):  
A. THIEL ◽  
B. ZICKMANN ◽  
W. A. STERTMANN ◽  
T. WYDERKA ◽  
G. HEMPELMANN
Keyword(s):  
Carbon Dioxide ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Artery Disease ◽  
Carbon Dioxide Reactivity ◽  
Cerebrovascular Carbon Dioxide Reactivity

Cerebrovascular reactivity in the caudate nucleus, lentiform nucleus and thalamus in patients with carotid artery disease

2017 ◽  
Vol 44 (2) ◽  
pp. 143-150 ◽  
Author(s):  
Nolan S. Hartkamp ◽  
Reinoud P.H. Bokkers ◽  
M.J.P. van Osch ◽  
Gert J. de Borst ◽  
Jeroen Hendrikse
Keyword(s):  
Carotid Artery ◽  
Caudate Nucleus ◽  
Carotid Artery Disease ◽  
Cerebrovascular Reactivity ◽  
Lentiform Nucleus ◽  
Artery Disease

scholarly journals Monitoring of Cerebral Vasodilatory Capacity With Transcranial Doppler Carbon Dioxide Inhalation in Patients With Severe Carotid Artery Disease

Stroke ◽  
2003 ◽  
Vol 34 (4) ◽  
pp. 945-949 ◽  
Author(s):  
Randolph S. Marshall ◽  
Tanja Rundek ◽  
Douglas M. Sproule ◽  
Brian-Fred M. Fitzsimmons ◽  
Shauna Schwartz ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Carotid Artery ◽  
Transcranial Doppler ◽  
Carotid Artery Disease ◽  
Artery Disease

scholarly journals Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease

2017 ◽  
Vol 38 (11) ◽  
pp. 2021-2032 ◽  
Author(s):  
Nolan S Hartkamp ◽  
Esben T Petersen ◽  
Michael A Chappell ◽  
Thomas W Okell ◽  
Maarten Uyttenboogaart ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Carotid Artery Disease ◽  
Tissue Level ◽  
Cerebrovascular Reactivity ◽  
Collateral Flow ◽  
Collateral Blood Flow ◽  
Ischaemic Damage ◽  
Before And After ◽  
Artery Disease

Collateral blood flow plays a pivotal role in steno-occlusive internal carotid artery (ICA) disease to prevent irreversible ischaemic damage. Our aim was to investigate the effect of carotid artery disease upon cerebral perfusion and cerebrovascular reactivity and whether haemodynamic impairment is influenced at brain tissue level by the existence of primary and/or secondary collateral. Eighty-eight patients with steno-occlusive ICA disease and 29 healthy controls underwent MR examination. The presence of collaterals was determined with time-of-flight, two-dimensional phase contrast MRA and territorial arterial spin labeling (ASL) imaging. Cerebral blood flow and cerebrovascular reactivity were assessed with ASL before and after acetazolamide. Cerebral haemodynamics were normal in asymptomatic ICA stenosis patients, as opposed to patients with ICA occlusion, in whom the haemodynamics in both hemispheres were compromised. Haemodynamic impairment in the affected brain region was always present in symptomatic patients. The degree of collateral blood flow was inversely correlated with haemodynamic impairment. Recruitment of secondary collaterals only occurred in symptomatic ICA occlusion patients. In conclusion, both CBF and cerebrovascular reactivity were found to be reduced in symptomatic patients with steno-occlusive ICA disease. The presence of collateral flow is associated with further haemodynamic impairment. Recruitment of secondary collaterals is associated with severe haemodynamic impairment.

Neurocognitive functioning and cerebrovascular reactivity after carotid endarterectomy

Neurology ◽  
2017 ◽  
Vol 90 (4) ◽  
pp. e307-e315 ◽  
Author(s):  
Simona Lattanzi ◽  
Luciano Carbonari ◽  
Gabriele Pagliariccio ◽  
Marco Bartolini ◽  
Claudia Cagnetti ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Endarterectomy ◽  
Cognitive Performance ◽  
Carotid Artery Disease ◽  
Cerebral Hemodynamics ◽  
Cerebrovascular Reactivity ◽  
Performance Change ◽  
Complex Figure ◽  
Artery Disease ◽  
Ica Stenosis

ObjectiveTo evaluate in patients with TIA and ipsilateral high-grade internal carotid artery (ICA) stenosis whether changes in cognitive performance and cerebral hemodynamics occurred after carotid endarterectomy (CEA) and to explore their relationship.MethodsParticipants were patients who underwent CEA, had TIA within the last 6 months, and had an ipsilateral severe ICA stenosis. Coloured Progressive Matrices (CPM) plus Complex Figure Copy Test (CFCT) and phonemic (ph) plus categorical (ca) Verbal Fluency (VF) tests were performed to assess right and left hemisphere cognitive functions, respectively. Hemodynamics was assessed with transcranial Doppler ultrasonography by means of the cerebral vasomotor reactivity (CVR) to hypercapnia.ResultsA total of 137 patients were included. Before CEA, patients with right ICA obtained lower scores on the CPM and CFCT; patients with left ICA stenosis performed worse on the phonemic and categorical VF tests. The CVR was decreased on the side of the stenosis. At 6 months from CEA, CVR and cognitive performance were significantly improved. The performance change in cognitive tests exploring the revascularized hemisphere was positively associated with the ipsilateral CVR variation (CPM: R2 for linear regression = 0.759, adjR2 = 0.737; CFCT: R2 = 0.734, adjR2 = 0.710; (ph)VF: R2 = 0.774, adjR2 = 0.749; (ca)VF: R2 = 0.732, adjR2 = 0.703).ConclusionCognitive performance was enhanced at 6 months since CEA, and the improvement was related to the CVR increase. Cerebral hemodynamics may be an independent and potentially reversible determinant of cognitive dysfunction in severe carotid artery disease.

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