Assessment of cerebrovascular reserve capacity in asymptomatic and symptomatic hemodynamically significant carotid stenoses and occlusions

László Orosz, B. Fülesdi, Arjan Hoksbergen, Georgios Settakis, J. Kollár, Martien Limburg, György Csécsei

Research output: Contribution to journalArticle

14 Citations (Scopus)

Abstract

BACKGROUND: Cerebrovascular reactivity measurements are believed to be a helpful tool for selecting patients who are at higher risk for hemodynamic strokes. The aim of this study was to compare cerebral vasoreactivity among patients suffering from internal carotid artery stenosis of different severity (asymptomatic stenosis, asymptomatic occlusion, symptomatic stenosis, symptomatic occlusion). METHODS: Sixty-two patients with asymptomatic and symptomatic internal carotid artery stenoses and occlusions underwent transcranial Doppler-acetazolamide tests. Absolute velocities of the middle cerebral arteries (MCAV), percent increases of the MCAV at different time points of the test (cerebrovascular reactivity, CVR) and maximal percent increase after administration of acetazolamide (cerebrovascular reserve, CRC) were compared on the affected and non-affected sides. Asymmetry indices (CRC affected side/CRC non-affected side) were compared between the groups of different severity of obstructive lesion. RESULTS: Resting MCAV was similar on both sides in all groups. A significant side-difference of the MCAV values after acetazolamide was observed only in the symptomatic groups. Difference of cerebrovascular reserve capacity between the affected and non-affected side was statistically significant only in the symptomatic groups (CRC symptomatic stenosis 36.6 ± 20.9% vs. 71.1 ± 27.9%, CRC symptomatic occlusion: 31.2 ± 24.6% vs. 64.5 ± 29.7%). Asymmetry index of the CRC was near to 1 in the asymptomatic stenosis group only, while in all the other groups this index referred to a significant hemispheric asymmetry of the vasoreactivity. CONCLUSIONS: Although in general cerebrovascular reserve capacity is compromised in cases of hemodynamically significant carotid lesions, there is a large individual variability within the subgroups. Further randomized studies are needed to clarify whether the clinical efficiency of carotid endarterectomy and extra-intracranial bypass may be improved by selecting the patients using hemodynamic criteria.

Original languageEnglish
Pages (from-to)333-339
Number of pages7
JournalSurgical Neurology
Volume57
Issue number5
DOIs
Publication statusPublished - 2002

Fingerprint

Carotid Stenosis
Acetazolamide
Pathologic Constriction
Hemodynamics
Carotid Endarterectomy
Middle Cerebral Artery
Stroke

Keywords

  • Acetazolamide
  • Carotid artery stenosis
  • Cerebrovascular reactivity and reserve capacity
  • Transcranial Doppler

ASJC Scopus subject areas

  • Clinical Neurology
  • Surgery

Cite this

Assessment of cerebrovascular reserve capacity in asymptomatic and symptomatic hemodynamically significant carotid stenoses and occlusions. / Orosz, László; Fülesdi, B.; Hoksbergen, Arjan; Settakis, Georgios; Kollár, J.; Limburg, Martien; Csécsei, György.

In: Surgical Neurology, Vol. 57, No. 5, 2002, p. 333-339.

Research output: Contribution to journalArticle

Orosz, László ; Fülesdi, B. ; Hoksbergen, Arjan ; Settakis, Georgios ; Kollár, J. ; Limburg, Martien ; Csécsei, György. / Assessment of cerebrovascular reserve capacity in asymptomatic and symptomatic hemodynamically significant carotid stenoses and occlusions. In: Surgical Neurology. 2002 ; Vol. 57, No. 5. pp. 333-339.
@article{7c2f31406ee44bdea1450ae75189225d,
title = "Assessment of cerebrovascular reserve capacity in asymptomatic and symptomatic hemodynamically significant carotid stenoses and occlusions",
abstract = "BACKGROUND: Cerebrovascular reactivity measurements are believed to be a helpful tool for selecting patients who are at higher risk for hemodynamic strokes. The aim of this study was to compare cerebral vasoreactivity among patients suffering from internal carotid artery stenosis of different severity (asymptomatic stenosis, asymptomatic occlusion, symptomatic stenosis, symptomatic occlusion). METHODS: Sixty-two patients with asymptomatic and symptomatic internal carotid artery stenoses and occlusions underwent transcranial Doppler-acetazolamide tests. Absolute velocities of the middle cerebral arteries (MCAV), percent increases of the MCAV at different time points of the test (cerebrovascular reactivity, CVR) and maximal percent increase after administration of acetazolamide (cerebrovascular reserve, CRC) were compared on the affected and non-affected sides. Asymmetry indices (CRC affected side/CRC non-affected side) were compared between the groups of different severity of obstructive lesion. RESULTS: Resting MCAV was similar on both sides in all groups. A significant side-difference of the MCAV values after acetazolamide was observed only in the symptomatic groups. Difference of cerebrovascular reserve capacity between the affected and non-affected side was statistically significant only in the symptomatic groups (CRC symptomatic stenosis 36.6 ± 20.9{\%} vs. 71.1 ± 27.9{\%}, CRC symptomatic occlusion: 31.2 ± 24.6{\%} vs. 64.5 ± 29.7{\%}). Asymmetry index of the CRC was near to 1 in the asymptomatic stenosis group only, while in all the other groups this index referred to a significant hemispheric asymmetry of the vasoreactivity. CONCLUSIONS: Although in general cerebrovascular reserve capacity is compromised in cases of hemodynamically significant carotid lesions, there is a large individual variability within the subgroups. Further randomized studies are needed to clarify whether the clinical efficiency of carotid endarterectomy and extra-intracranial bypass may be improved by selecting the patients using hemodynamic criteria.",
keywords = "Acetazolamide, Carotid artery stenosis, Cerebrovascular reactivity and reserve capacity, Transcranial Doppler",
author = "L{\'a}szl{\'o} Orosz and B. F{\"u}lesdi and Arjan Hoksbergen and Georgios Settakis and J. Koll{\'a}r and Martien Limburg and Gy{\"o}rgy Cs{\'e}csei",
year = "2002",
doi = "10.1016/S0090-3019(02)00689-4",
language = "English",
volume = "57",
pages = "333--339",
journal = "World Neurosurgery",
issn = "1878-8750",
publisher = "Elsevier Inc.",
number = "5",

}

TY - JOUR

T1 - Assessment of cerebrovascular reserve capacity in asymptomatic and symptomatic hemodynamically significant carotid stenoses and occlusions

AU - Orosz, László

AU - Fülesdi, B.

AU - Hoksbergen, Arjan

AU - Settakis, Georgios

AU - Kollár, J.

AU - Limburg, Martien

AU - Csécsei, György

PY - 2002

Y1 - 2002

N2 - BACKGROUND: Cerebrovascular reactivity measurements are believed to be a helpful tool for selecting patients who are at higher risk for hemodynamic strokes. The aim of this study was to compare cerebral vasoreactivity among patients suffering from internal carotid artery stenosis of different severity (asymptomatic stenosis, asymptomatic occlusion, symptomatic stenosis, symptomatic occlusion). METHODS: Sixty-two patients with asymptomatic and symptomatic internal carotid artery stenoses and occlusions underwent transcranial Doppler-acetazolamide tests. Absolute velocities of the middle cerebral arteries (MCAV), percent increases of the MCAV at different time points of the test (cerebrovascular reactivity, CVR) and maximal percent increase after administration of acetazolamide (cerebrovascular reserve, CRC) were compared on the affected and non-affected sides. Asymmetry indices (CRC affected side/CRC non-affected side) were compared between the groups of different severity of obstructive lesion. RESULTS: Resting MCAV was similar on both sides in all groups. A significant side-difference of the MCAV values after acetazolamide was observed only in the symptomatic groups. Difference of cerebrovascular reserve capacity between the affected and non-affected side was statistically significant only in the symptomatic groups (CRC symptomatic stenosis 36.6 ± 20.9% vs. 71.1 ± 27.9%, CRC symptomatic occlusion: 31.2 ± 24.6% vs. 64.5 ± 29.7%). Asymmetry index of the CRC was near to 1 in the asymptomatic stenosis group only, while in all the other groups this index referred to a significant hemispheric asymmetry of the vasoreactivity. CONCLUSIONS: Although in general cerebrovascular reserve capacity is compromised in cases of hemodynamically significant carotid lesions, there is a large individual variability within the subgroups. Further randomized studies are needed to clarify whether the clinical efficiency of carotid endarterectomy and extra-intracranial bypass may be improved by selecting the patients using hemodynamic criteria.

AB - BACKGROUND: Cerebrovascular reactivity measurements are believed to be a helpful tool for selecting patients who are at higher risk for hemodynamic strokes. The aim of this study was to compare cerebral vasoreactivity among patients suffering from internal carotid artery stenosis of different severity (asymptomatic stenosis, asymptomatic occlusion, symptomatic stenosis, symptomatic occlusion). METHODS: Sixty-two patients with asymptomatic and symptomatic internal carotid artery stenoses and occlusions underwent transcranial Doppler-acetazolamide tests. Absolute velocities of the middle cerebral arteries (MCAV), percent increases of the MCAV at different time points of the test (cerebrovascular reactivity, CVR) and maximal percent increase after administration of acetazolamide (cerebrovascular reserve, CRC) were compared on the affected and non-affected sides. Asymmetry indices (CRC affected side/CRC non-affected side) were compared between the groups of different severity of obstructive lesion. RESULTS: Resting MCAV was similar on both sides in all groups. A significant side-difference of the MCAV values after acetazolamide was observed only in the symptomatic groups. Difference of cerebrovascular reserve capacity between the affected and non-affected side was statistically significant only in the symptomatic groups (CRC symptomatic stenosis 36.6 ± 20.9% vs. 71.1 ± 27.9%, CRC symptomatic occlusion: 31.2 ± 24.6% vs. 64.5 ± 29.7%). Asymmetry index of the CRC was near to 1 in the asymptomatic stenosis group only, while in all the other groups this index referred to a significant hemispheric asymmetry of the vasoreactivity. CONCLUSIONS: Although in general cerebrovascular reserve capacity is compromised in cases of hemodynamically significant carotid lesions, there is a large individual variability within the subgroups. Further randomized studies are needed to clarify whether the clinical efficiency of carotid endarterectomy and extra-intracranial bypass may be improved by selecting the patients using hemodynamic criteria.

KW - Acetazolamide

KW - Carotid artery stenosis

KW - Cerebrovascular reactivity and reserve capacity

KW - Transcranial Doppler

UR - http://www.scopus.com/inward/record.url?scp=0036067512&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0036067512&partnerID=8YFLogxK

U2 - 10.1016/S0090-3019(02)00689-4

DO - 10.1016/S0090-3019(02)00689-4

M3 - Article

VL - 57

SP - 333

EP - 339

JO - World Neurosurgery

JF - World Neurosurgery

SN - 1878-8750

IS - 5

ER -