scholarly journals Cerebral vasomotor reactivity and apnea test in symptomatic and asymptomatic high-grade carotid stenosis

2015 ◽  
Vol 143 (9-10) ◽  
pp. 520-524 ◽  
Author(s):  
Aleksandra Lucic-Prokin ◽  
Petar Slankamenac ◽  
Pavle Kovacevic ◽  
Svetlana Ruzicka-Kaloci ◽  
Zeljko Zivanovic
Keyword(s):  
Carotid Stenosis ◽  
Collateral Circulation ◽  
Breath Holding ◽  
High Grade ◽  
Apnea Test ◽  
Asymptomatic Carotid ◽  
Vasomotor Reactivity ◽  
Cerebral Vasomotor Reactivity ◽  
The Impact ◽  
Breath Holding Index

Introduction. Cerebral vasomotor reactivity (VMR) represents an autoregulatory response of the arterial trunks on the specific vasoactive stimuli, most commonly CO2. Objective. The aim of this retrospective study was to compare VMR in high-grade symptomatic (SCAS) and asymptomatic carotid stenosis (ACAS), using the apnea test to evaluate the hemodynamic status. Methods. The study included 50 patients who were hospitalized at the neurology and vascular surgery departments as part of preparation for carotid endarterectomy. We evaluated VMR by calculating the breath holding index (BHI) in 34 patients with SCAS and 16 patients with ACAS, with isolated high-grade carotid stenosis. We evaluated the impact of risk factors and collateral circulation on BHI, as well as the correlation between the degree of carotid stenosis and BHI. Results. A pathological BHI was more frequent in the SCAS group (p<0.01). There was no difference in the range of BHI values between the groups, both ipsilaterally and contralaterally. Only male gender was associated with pathological BHI in both groups (p<0.05). Collateral circulation did not exist in over 60% of all subjects. We confirmed a negative correlation between the degree of carotid stenosis and BHI. Conclusion. SCAS and ACAS patients present with different hemodynamics. While ACAS patients have stable hemodynamics, combination of hemodynamic and thromboembolic effects is characteristic of SCAS patients.

Erenumab does not alter cerebral hemodynamics and endothelial function in migraine without aura

Cephalalgia ◽  
2020 ◽  
pp. 033310242095669
Author(s):  
Claudia Altamura ◽  
Giovanna Viticchi ◽  
Adriana Fallacara ◽  
Carmelina Maria Costa ◽  
Nicoletta Brunelli ◽  
...  
Keyword(s):  
Cerebral Arteries ◽  
Breath Holding ◽  
Flow Mediated Dilation ◽  
Mean Flow ◽  
Vasomotor Reactivity ◽  
Headache Centre ◽  
Cerebral Vasomotor Reactivity ◽  
Fourth Dose ◽  
Corrected Flow ◽  
Breath Holding Index

Objective To assess whether erenumab influences cerebral vasomotor reactivity and flow-mediated dilation in migraine patients. Methods Consecutive migraineurs prescribed erenumab at our Headache Centre and age and sex-matching controls were invited to participate in this observational longitudinal study. Patients were evaluated for cerebral vasomotor reactivity to hypercapnia (breath-holding index) in middle and posterior cerebral arteries and for brachial corrected flow mediated dilation at baseline (T0), after 2 weeks from the first erenumab injection (T2) and after 2 weeks from the fourth Erenumab injection (T18). Patients displaying a reduction of at least 50% in monthly migraine days after completing the fourth month of therapy were classified as responders. Results Sixty patients and 25 controls agreed to participate. Middle and posterior cerebral artery mean flow velocities, breath-holding index and flow-mediated dilation did not differ at T0 and from T0 to T2 in patients and controls. In patients, we neither observed a variation of the explored variables from T0 to T18 nor an interaction between evaluation times (T0–T2 or T0–T18) and chronic condition at T0, responder state or erenumab fourth dose. Conclusions Our findings demonstrate that erenumab preserves cerebral vasomotor reactivity and flow-mediated dilation in migraineurs without aura.

scholarly journals The impact of aging on cerebral vasomotor reactivity to carbon dioxide (1069.5)

2014 ◽  
Vol 28 (S1) ◽  
Author(s):  
Jonathan Riley ◽  
Takashi Tarumi ◽  
Rosemary Parker ◽  
Kyle Armstrong ◽  
Cynthia Tinajero ◽  
...  
Keyword(s):  
Carbon Dioxide ◽  
Vasomotor Reactivity ◽  
Cerebral Vasomotor Reactivity ◽  
The Impact

Detected Bruit

2016 ◽  
Author(s):  
Ji Y. Chong ◽  
Michael P. Lerario
Keyword(s):  
Risk Factor ◽  
Carotid Stenosis ◽  
Clinical Characteristics ◽  
Female Gender ◽  
Treatment Decisions ◽  
High Grade ◽  
Asymptomatic Carotid Stenosis ◽  
Asymptomatic Carotid ◽  
Patient Demographic ◽  
Risks And Benefits

Carotid stenosis is a risk factor for stroke. Revascularization of high-grade asymptomatic carotid stenosis in select patients can lower the risk of incident stroke. Endarterectomy and stenting are both associated with periprocedural risk. Risks and benefits need to be evaluated carefully before proceeding with any intervention. Certain patient demographic and clinical characteristics, such as female gender, may reduce the benefits of surgery and influence treatment decisions.

scholarly journals Transfer Function Analysis of Cerebral Hemodynamics in Patients with Carotid Stenosis

1999 ◽  
Vol 19 (4) ◽  
pp. 460-465 ◽  
Author(s):  
Han-Hwa Hu ◽  
Terry Bo-Jau Kuo ◽  
Wen-Jang Wong ◽  
Yun-On Luk ◽  
Chang-Ming Chern ◽  
...  
Keyword(s):  
Transfer Function ◽  
Carotid Stenosis ◽  
Phase Angle ◽  
Cerebral Autoregulation ◽  
Function Analysis ◽  
Low Frequency ◽  
High Grade ◽  
Vasomotor Reactivity ◽  
Transfer Function Analysis ◽  
Spontaneous Fluctuations

This study evaluates the validity of the transfer function analysis of spontaneous fluctuations of arterial blood pressure (ABP) and blood flow velocity of the middle cerebral artery (MCAFV) as a simple, convenient method to assess human cerebral autoregulation in patients with carotid stenosis. Eighty-three consecutive patients with various degrees of carotid stenosis and 37 healthy controls were enrolled. The carotid stenosis was graded based on the diagnostic criteria of duplex ultrasound. Instantaneous bilateral MCAFV and ABP of all participants were assessed noninvasively using transcranial Doppler sonography and the servocontrolled infrared finger plethysmography, respectively. Spectral analyses of ABP and MCAFV were performed by fast Fourier transform. The fluctuations in ABP as well as in MCAFV were diffracted into three components at specific frequency ranges designated as high-frequency (HF; 0.15 to 0.4 Hz), low-frequency (LF; 0.04 to 0.15 Hz), and very low-frequency (VLF; 0.016 to 0.04 Hz). Cross-spectral analysis was applied to quantify the coherence, transfer phase, and magnitude in individual HF, LF, and VLF components. Transcranial Doppler CO2 vasomotor reactivity was measured with 5% CO2 inhalation. The LF phase angle (r = −0.53, P < 0.001); magnitude of VLF (r = −0.29, P = 0.002), LF (r = −0.35, P < 0.001), and HF (r = −0.47, P < 0.001); and CO2 vasomotor reactivity (r = −0.66, P < 0.001) were negatively correlated with the severity of stenosis. Patients with unilateral high-grade (greater than 90% stenosis) carotid stenosis demonstrated significant reduction in LF phase angle ( P < 0.001) and HF magnitude ( P = 0.018) on the ipsilateral side of the affected vessel compared with their contralateral side. The study also revealed a high sensitivity, specificity, and accuracy using LF phase angle and HF magnitude to detect a high-grade carotid stenosis. A strong correlation existed between the LF phase angle and the CO2 vasomotor reactivity test (r = 0.62, P < 0.001), and the correlation between the HF magnitude and the CO2 vasomotor reactivity (r = 0.44, P < 0.001) was statistically significant as well. We conclude that transfer function analysis of spontaneous fluctuations of MCAFV and ABP could be used to identify hemodynamically significant high-grade carotid stenosis with impaired cerebral autoregulation or vasomotor reserve.

scholarly journals Comparison of different carotid stent designs in endovascular therapy of severe carotid artery stenosis

2020 ◽  
Vol 4 (1) ◽  
pp. 2514183X2093241
Author(s):  
Philipp Gruber ◽  
Jatta Berberat ◽  
Timo Kahles ◽  
Javier Anon ◽  
Michael Diepers ◽  
...  
Keyword(s):  
Carotid Artery ◽  
Carotid Stenosis ◽  
Carotid Artery Stenosis ◽  
Recurrent Stroke ◽  
Artery Stenosis ◽  
High Grade ◽  
Carotid Stent ◽  
Asymptomatic Carotid ◽  
Stent System ◽  
Elective Patients

Background: One of the major periprocedural risks of carotid artery stenting is embolism caused either by plaque debris or by local thrombus forming. Double-layer micromesh stent design has shown to lower the chance of debris embolism but might have a slightly higher risk of local thrombus forming. Thus, we compared two different stent designs regarding safety and outcome profile in elective patients with high-grade carotid artery stenosis using a self-expanding, double-layer micromesh carotid stent system (DLCS) or a self-expanding hybrid carotid stent system (HCS). Methods: A single-center, open-label, retrospective cohort study of 67 consecutive, elective patients with high-grade symptomatic and asymptomatic carotid stenosis was executed at a comprehensive stroke center. Outcome measures were reocclusion rate, periprocedural symptomatic ischemic events, as well as other periprocedural complications, and recurrent stroke and mortality at 30 days’ follow-up. Results: Thirty-two patients (24% women, median age 75 years (interquartile range (IQR) 71–80) were treated with DLCS, and 35 patients (29% women, median age 71 years (IQR 63–76) years) with HCS. In both groups, pretreatment carotid stenosis degree was similar (median NASCET of 80%). Successful deployment was achieved in all cases without technical failure, and both groups did not differ in reocclusion rates, recurrent stroke, and mortality within 30 days. Conclusions: DCLS and HCS revealed to have similar safety and outcome profile in elective patients with high-grade symptomatic as well as asymptomatic carotid artery stenosis.

scholarly journals Ten-year risk of stroke in patients with previous cerebral infarction and the impact of carotid surgery in the Asymptomatic Carotid Surgery Trial

2016 ◽  
Vol 11 (9) ◽  
pp. 1020-1027 ◽  
Author(s):  
Jonathan Y Streifler ◽  
Anne G den Hartog ◽  
Samuel Pan ◽  
Hongchao Pan ◽  
Richard Bulbulia ◽  
...  
Keyword(s):  
Cerebral Infarction ◽  
Carotid Endarterectomy ◽  
Carotid Stenosis ◽  
Hazard Ratio ◽  
Carotid Surgery ◽  
Asymptomatic Carotid ◽  
Risk Increase ◽  
Surgery Trial ◽  
The Impact

Background Silent brain infarcts are common in patients at increased risk of stroke and are associated with a poor prognosis. In patients with asymptomatic carotid stenosis, similar adverse associations were claimed, but the impact of previous infarction or symptoms on the beneficial effects of carotid endarterectomy is not clear. Our aim was to evaluate the impact of prior cerebral infarction in patients enrolled in the Asymptomatic Carotid Surgery Trial, a large trial with 10-year follow-up in which participants whose carotid stenosis had not caused symptoms for at least six months were randomly allocated either immediate or deferred carotid endarterectomy. Methods The first Asymptomatic Carotid Surgery Trial included 3120 patients. Of these, 2333 patients with baseline brain imaging were identified and divided into two groups irrespective of treatment assignment, 1331 with evidence of previous cerebral infarction, defined as a history of ischemic stroke or transient ischemic attack > 6 months prior to randomization or radiological evidence of an asymptomatic infarct (group 1) and 1002 with normal imaging and no prior stroke or transient ischemic attack (group 2). Stroke and vascular deaths were compared during follow-up, and the impact of carotid endarterectomy was observed in both groups. Results Baseline characteristics of patients with and without baseline brain imaging were broadly similar. Of those included in the present report, male gender and hypertension were more common in group 1, while mean ipsilateral stenosis was slightly greater in group 2. At 10 years follow-up, stroke was more common among participants with cerebral infarction before randomization (absolute risk increase 5.8% (1.8–9.8), p = 0.004), and the risk of stroke and vascular death was also higher in this group (absolute risk increase 6.9% (1.9–12.0), p = 0.007). On multivariate analysis, prior cerebral infarction was associated with a greater risk of stroke (hazard ratio = 1.51, 95% confidence interval: 1.17–1.95, p = 0.002) and of stroke or other vascular death (hazard ratio = 1.30, 95% confidence interval: 1.11–1.52, p = 0.001). At 10 years, greater absolute benefits from immediate carotid endarterectomy were seen in those patients with prior cerebral infarction (6.7% strokes immediate carotid endarterectomy vs. 14.7% delayed carotid endarterectomy; hazard ratio 0.47 (0.34–0.65), p = 0.003), compared to those lower risk patients without prior cerebral infarction (6.0% vs. 9.9%, respectively; hazard ratio 0.61 (0.39–0.94), p = 0.005), though it must be emphasized that the first Asymptomatic Carotid Surgery Trial was not designed to test this retrospective and non-randomized comparison. Conclusions Asymptomatic carotid stenosis patients with prior cerebral infarction have a higher stroke risk during long-term follow-up than those without prior cerebral infarction. Evidence of prior ischemic events might help identify patients in whom carotid intervention is particularly beneficial.

scholarly journals Cerebral Vasomotor Reactivity during Hypo- and Hypercapnia in Sedentary Elderly and Masters Athletes

2013 ◽  
Vol 33 (8) ◽  
pp. 1190-1196 ◽  
Author(s):  
Yong-Sheng Zhu ◽  
Takashi Tarumi ◽  
Benjamin Y Tseng ◽  
Dean M Palmer ◽  
Benjamin D Levine ◽  
...  
Keyword(s):  
Exercise Training ◽  
Aerobic Exercise ◽  
Aerobic Exercise Training ◽  
Vasomotor Reactivity ◽  
Arterial Blood ◽  
Cerebrovascular Function ◽  
Age Related ◽  
Masters Athletes ◽  
Cerebral Vasomotor Reactivity ◽  
The Impact

Physical activity may influence cerebrovascular function. The objective of this study was to determine the impact of life-long aerobic exercise training on cerebral vasomotor reactivity (CVMR) to changes in end-tidal CO2 (EtCO2) in older adults. Eleven sedentary young (SY, 27 ± 5 years), 10 sedentary elderly (SE, 72 ± 4 years), and 11 Masters athletes (MA, 72 ± 6 years) underwent the measurements of cerebral blood flow velocity (CBFV), arterial blood pressure, and EtCO2 during hypocapnic hyperventilation and hypercapnic rebreathing. Baseline CBFV was lower in SE and MA than in SY while no difference was observed between SE and MA. During hypocapnia, CVMR was lower in SE and MA compared with SY (1.87 ± 0.42 and 1.47 ± 0.21 vs. 2.18 ± 0.28 CBFV%/mm Hg, P < 0.05) while being lowest in MA among all groups ( P < 0.05). In response to hypercapnia, SE and MA exhibited greater CVMR than SY (6.00 ± 0.94 and 6.67 ± 1.09 vs. 3.70 ± 1.08 CBFV1%/mm Hg, P < 0.05) while no difference was observed between SE and MA. A negative linear correlation between hypo- and hypercapnic CVMR ( R2 = 0.37, P < 0.001) was observed across all groups. Advanced age was associated with lower resting CBFV and lower hypocapnic but greater hypercapnic CVMR. However, life-long aerobic exercise training appears to have minimal effects on these age-related differences in cerebral hemodynamics.

Prolonged cerebral circulation time is more associated with symptomatic carotid stenosis than stenosis degree or collateral circulation

2017 ◽  
Vol 10 (5) ◽  
pp. 476-480 ◽  
Author(s):  
Yong-Sin Hu ◽  
Wan-Yuo Guo ◽  
I-Hui Lee ◽  
Feng-Chi Chang ◽  
Chung-Jung Lin ◽  
...  
Keyword(s):  
Carotid Stenosis ◽  
Cerebral Circulation ◽  
Collateral Circulation ◽  
Stroke Risk ◽  
Circulation Time ◽  
High Grade ◽  
Symptomatic Carotid ◽  
Symptomatic Carotid Stenosis ◽  
The Difference ◽  
Cerebral Circulation Time

Background and purposeCurrent practice of revascularization for carotid stenosis (CS) primarily relies on symptoms and degree of stenosis. Other parameters, such as collateral circulation and cerebral circulation time (CCT), might influence the stroke risk in CS. This study was conducted to (1) investigate whether CCT is more associated with symptomatic CS than degree of stenosis and (2) elucidate the associations among the degree of stenosis, collateral status, and CCT.MethodsFrom 2010 to 2016, 82 patients with unilateral CS were enrolled for DSA and divided into symptomatic and asymptomatic groups based on clinical presentation. CCT was defined as the difference between the time taken by the cavernous internal carotid artery and parietal vein to reach the maximal contrast medium intensities on lateral DSA. The degree of stenosis, collateral status, and CCT of the two groups were compared. Logistic regression analysis was performed to estimate the OR for symptomatic CS with the imaging variables.ResultsThe symptomatic group had a significantly higher degree of stenosis and longer CCT. CCT (OR 1.95, p=0.013) was more associated with symptomatic CS than the degree of stenosis (OR 1.03, p=0.229), after adjustment for potential confounders—namely, age, sex, antithrombotic use, and collateral status. Symptomatic high grade CS with collaterals had a non-significantly shorter CCT than those without collaterals.ConclusionsDSA derived CCT is more reflective of the hemodynamic differences between symptomatic and asymptomatic CS than degree of stenosis. Collaterals may not effectively reduce CCT in symptomatic high grade CS.

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