Relevance of cerebral vasomotor reactivity to prospects for successful endarterectomy

Fürst, H.; Hartl, W; Jansen, Ingrid; Sutter, T.; Lauterjung, L.; Fw, Schildberg

doi:10.1016/0140-6736(90)90038-7

Cited by 8 publications

(4 citation statements)

References 4 publications

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“…They found that surgery improved intracerebral hemodynamics ipsilateral to ICA stenosis only in patients who preoperatively had a reduced cerebral perfusion pressure at the side of ICA stenosis of at least 20% (indicating inadequate intracerebral collateralization) compared with the pressure in the common carotid artery. Halsey et al, 24 Widder et al, 25 and our group 26 reported a significant inverse correlation between the preoperative CBF reactivity, flow velocity reactivity, or CR, reactivity ipsilateral to ICA occlusion or stenosis and the change in reactivity after surgery. Correspondingly, Vorstrup et al, 27 Russel et al, 28 and Karnik et al 29 found that surgery significantly improved CBF or flow velocity reactivity (as evaluated by the acetazolamide test) only in patients who had an abnormal side-to-side asymmetry in reactivity before surgery.…”

Section: -23mentioning

confidence: 99%

Effect of carotid endarterectomy on patterns of cerebrovascular reactivity in patients with unilateral carotid artery stenosis.

Hartl

Janssen

Fürst

1994

Stroke

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Patients with unilateral significant carotid artery stenosis present with a variable intracranial hemodynamic status. In the majority of patients, hemodynamics are normal because of sufficient collateral flow. One subgroup shows poor ipsilateral hemodynamics because of a severely reduced blood supply, whereas in another subgroup of patients a steal phenomenon from the contralateral to the ipsilateral hemisphere can be observed during pharmacological provocation. The present study examined the effect of carotid endarterectomy (CEA) on these patterns of cerebrovascular hemodynamics in patients with carotid artery stenosis. The CO2 reactivity of the cerebral resistance index (CRi) was determined with transcranial Doppler sonography in 63 patients with unilateral high-grade to threadlike carotid artery stenosis before and 3 months after CEA and in 37 control subjects. The interhemispheric asymmetry of CRi reactivity of the control group was used to differentiate between normal and abnormal findings. In patients with normal CRi asymmetry (comparable CRi reactivities at both hemispheres, n = 41), CEA did not change hemispheric CRi reactivity. In patients in whom CRi reactivity was absent at the contralateral hemisphere (intracerebral steal during hypercapnia, n = 12), CEA abolished the steal phenomenon by significantly increasing CRi reactivity at the contralateral hemisphere (preoperative, -1.0 +/- 2.1 %CRi/vol%CO2; postoperative, 5.2 +/- 0.7 %CRi/vol%CO2; P < .01). Patients who showed severely diminished ipsilateral CRi reactivity, compatible with a significantly reduced perfusion pressure at the poststenotic hemisphere (n = 10), demonstrated an improvement of ipsilateral CRi reactivity after surgery (preoperative, 0.6 +/- 0.8 %CRi/vol%CO2; postoperative, 3.7 +/- 1.1 %CRi/vol%CO2; P < .01). Most patients do not respond significantly to CEA. One small subgroup of patients who presented with severely disturbed ipsilateral hemodynamics demonstrated postoperative improvement at the poststenotic hemisphere, whereas in another small subgroup, who showed a steal phenomenon at the contralateral hemisphere, CEA improved contralateral hemodynamics. Determination of preoperative CRi reactivity allowed precise prediction of the effect of CEA on intracerebral hemodynamics.

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Section: -23mentioning

confidence: 99%

Effect of carotid endarterectomy on patterns of cerebrovascular reactivity in patients with unilateral carotid artery stenosis.

Hartl

Janssen

Fürst

1994

Stroke

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“…Functional blood flow data could be gained from PET scanning using either 13 NH 3 or 0 5 0 2 , single-photon emission computed tomography (SPECT) [21,22], xenon-enhanced CT [23], and TCD taken before, during, and after various provocative techniques [12,24,25]. I could not do PET or xenon-enhanced CT for lack of equipment, but I felt that SPECT might be helpful.…”

Section: Brain and Vascular Function Testingmentioning

confidence: 99%

“…I contemplated using TCD with provocative testing but I had little experience with these techniques. TCD and SPECT can be used to study changes in blood flow in response to stimuli that usually augment flow [24,25]. At present, the most commonly used stimulus is acetazolamide.…”

Section: Brain and Vascular Function Testingmentioning

confidence: 99%

“…Are collateral channels functioning maximally and so unable to do more? Some have posited that lack of reserve might be used to help determine which patients should have carotid endarterectomy or other therapeutic procedures [25]. SPECT or xenon-enhanced CT could be used rather than TCD to provide a visual image of the blood flow response to vasodilatory stimuli.…”

Section: Brain and Vascular Function Testingmentioning

confidence: 99%

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