Decreased transcranial Doppler carbon dioxide reactivity is associated with disordered cerebral metabolism in patients with internal carotid artery stenosis

Visser, Gha; Huffelen, Alexander C. van; Wieneke, G.H.; Eikelboom, B.C.

doi:10.1016/s0741-5214(99)70135-7

Cited by 17 publications

(5 citation statements)

References 32 publications

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“…TCD‐based techniques are cheap and simple and are tolerated by almost all patients. Impaired reactivity determined using this method correlated with evidence of ischaemia on magnetic resonance spectroscopy, as determined by the presence of lactate and a reduction in the neuronal marker N ‐acetyl aspartate 15 . It also correlated with vasodilatation, detected as an increased cerebral blood volume (CBV) to cerebral blood flow (CBF) ratio, estimated by positron emission tomography (PET) 16 .…”

Section: Discussionmentioning

confidence: 90%

“…Impaired reactivity determined using this method correlated with evidence of ischaemia on magnetic resonance spectroscopy, as determined by the presence of lactate and a reduction in the neuronal marker N-acetyl aspartate. 15 It also correlated with vasodilatation, detected as an increased cerebral blood volume (CBV) to cerebral blood flow (CBF) ratio, estimated by positron emission tomography (PET). 16 Other options include stable xenon-CT (also used in our unit), single photon emission computed tomography (SPECT), PET, and magnetic resonance imaging (MRI) to have quantitative or relative measurement of CBF and CBV.…”

Section: -11mentioning

confidence: 98%

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Impaired transcranial Doppler ultrasound cerebrovascular reactivity before carotid intervention is not predictive of a subsequent ischaemic event

Wong¹,

Ng²,

Chan

et al. 2008

Surgical Practice

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Aim:After carotid endarterectomy (CEA) or carotid angioplasty and stenting (CAS) for patients with severe carotid stenosis, an ischaemic event may still happen in up to 9% of patients over a 2 year period. We aimed to investigate whether baseline cerebrovascular reactivity could predict a subsequent ischaemic event after intervention. Methods: A total of 51 patients with severe carotid stenosis (more than 70% stenosis from ultrasonography) and data on cerebrovascular reactivity were reviewed. Thirty-six patients had either CEA or CAS performed and were recruited for analysis. Transcranial Doppler ultrasonography was used to examine the reactivity of the middle cerebral artery to 5% carbon dioxide in oxygen. Normal cerebrovascular reactivity was defined by >1% increase per unit change in end-tidal CO2 in ipsilateral middle cerebral artery velocity in response to 5% carbon dioxide in oxygen. The mean follow-up period was 66 months. Results: Twenty-six patients had symptomatic carotid stenosis and 10 patients had asymptomatic carotid stenosis. There were four subsequent ischaemic events during follow up. None of the nine patients with impaired baseline ipsilateral cerebrovascular reactivity had a subsequent ischaemic event. Conclusion: From our patient cohort, impaired baseline ipsilateral cerebrovascular reactivity before carotid intervention was not predictive of a subsequent ischaemic event.

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Section: Discussionmentioning

confidence: 90%

Section: -11mentioning

confidence: 98%

Impaired transcranial Doppler ultrasound cerebrovascular reactivity before carotid intervention is not predictive of a subsequent ischaemic event

Wong¹,

Ng²,

Chan

et al. 2008

Surgical Practice

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“…Visser et al 28 found a positive correlation between the ratio of NAA to choline and cerebral vasoreactivity in patients with severe ICA stenosis. However, they included asymptomatic patients, which may have influenced the observed correlation.…”

Section: Discussionmentioning

confidence: 98%

Cerebral Hemodynamics and Metabolism in Patients With Symptomatic Occlusion of the Internal Carotid Artery

Rutgers

Osch

Kappelle

et al. 2003

Stroke

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Background and Purpose-The goals of this study were to investigate (1) whether the concentrations of choline, creatine, and N-acetyl aspartate (NAA) in cerebral white matter are changed in patients with symptomatic occlusion of the internal carotid artery (ICA) and (2) whether possible changes in metabolite concentration are related to regional cerebral perfusion or cerebral vasoreactivity. Methods-In 19 patients (meanϮSD age, 60Ϯ9 years), white matter metabolite concentrations were measured with proton MR spectroscopic imaging on average 4Ϯ2 months after symptoms occurred. In selected voxels, corresponding cerebral blood flow and volume, mean transit time, and time-to-bolus peak were determined with dynamic susceptibility contrast MRI. Cerebral CO 2 reactivity was determined with transcranial Doppler sonography. Results-No significant changes in choline and creatine concentrations were observed. NAA concentration was significantly reduced in the hemisphere on the side of the symptomatic ICA (9.1Ϯ1.7 mmol/L) compared with the contralateral hemisphere (10.5Ϯ1.7 mmol/L, PϽ0.005) and control subjects (10.5Ϯ0.9 mmol/L, PϽ0.01). Although no significant interhemispheric difference in NAA concentration was found in patients who presented with retinal ischemia, patients with cerebral ischemia had a significantly lower NAA concentration in the symptomatic hemisphere (9.0Ϯ1.7 mmol/L) compared with the asymptomatic hemisphere (10.

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“…This technical defect may lead to blood flow disturbances and thromboembolism. 9,10 Some authors have argued that it is critical understanding of the pathophysiology of post-operative stroke in carotid artery surgery. Some of these stroke cases can be avoided and are associated with the shunt.…”

Section: Hemodynamic and Cerebral Measurementsmentioning

confidence: 99%

Evaluation of Shunt Use with Near Infrared Spectroscopy During Carotid Endarterectomy: An Observational Clinical Study

Öz¹,

Güler²,

Kahraman³

et al. 2017

Turkiye Klinikleri J Cardiovasc Sci

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A AB BS ST TR RA AC CT T O Ob bj je ec ct ti iv ve e: : Measurement of cerebral saturation (NIRS) with is that noninvasive method can early and easily demonstrate disorders in cerebral blood flow without the need for specialized personnel. In this study, we evaluated not only the relationship between cerebral monitoring values and shunt use but also postoperative short term effect of cerebral monitoring in patients undergoing carotid endarterectomy. M Ma at te er ri ia al l a an nd d M Me et th ho od ds s: : Between 2010 and 2015, 427 patients underwent 481 carotid endarterectomy operations. Sixty-five of these patients (13.5%) had bilateral critical carotid stenosis. Carotid endarterectomy was performed under shunt requirement in 54 cases (11.2%). The NIRS probe was placed in the frontal region of the patient to monitor the cerebral oxygen level of the patients. At this time, NIRS values of patients were recorded before cross-clamp (rSO 0), cross-clamp (rSO1) and post-clamp (rSO2). Following operation, the patients were transfered to intensive care unit and then to the ward after staying 2-4 hours. Operational time, cross-clamp time, complications within 30 days associated with operation were recorded. Subsequent checks were made by the neurologist on the 30th day and every 6 months on follow-up. R Re es su ul lt ts s: : The mean age was 69.95±12.84 in group 1 and 66.18±7.11 years in group 2. There was a significant difference in the carotid clamping time (min), percentage of carotid angioplasty, bilateral carotid procedures between group 1 and group 2 (23.85±12.4 vs 15.18±7.11, 100% vs 79.2%, 74.07 vs 5.85, p<0.01, respectively). The length of intensive care unit and hospital stays were similar among groups. regional cerebral oxygen saturation in first 3 min after carotid artery clamping (rSO1) in shunt group was lower compared to the patients in no-shunt group (48.7±11.5 vs 59.7±6.77, p=0.03) C Co on nc cl lu us si io on ns s: : As a result, NIRS is a safely and a reliable cerebral monitoring technique and also it may help to reduce unnecessary shunt use in patients undergoing carotid endarterectomy. K Ke ey yw wo or rd ds s: : Endarterectomy, carotid; spectroscopy, near-infrared Ö ÖZ ZE ET T A Am ma aç ç: : Near infrared spectroscopy (NIRS) ile serebral oksijen saturasyonu ölçümü, serebral kan akımının noninvaziv bir ölçümüdür. Bu çalışmada sadece karotis endarterektomi uygulanan hastalarda serebral monitörizasyon değerleri ile şant kullanımı arasındaki ilişkiyi değil, aynı zamanda postoperatif serebral monitörizasyon etkisini de değerlendirdik. G Ge er re eç ç v ve e Y Yö ön n--t te em ml le er r: : 2010 ile 2015 yılları arasında 427 hasta 481 karotis endarterektomi ameliyatı geçirdi. Bu hastalardan 65'inde (%13,5) bilateral kritik karotis stenozu vardı. 54 hastada (%11,2), karotis endarterektomi şant gereksinimi altında uygulandı. Near infrared spectroscopy ile, hastanın serebral oksijen seviyesini izlemek için frontal bölgeye elektrodlar yerleştirildi. Bu sırada, hastaların kross klemp öncesi (rSO 0), kro...

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Decreased transcranial Doppler carbon dioxide reactivity is associated with disordered cerebral metabolism in patients with internal carotid artery stenosis

Cited by 17 publications

References 32 publications

Impaired transcranial Doppler ultrasound cerebrovascular reactivity before carotid intervention is not predictive of a subsequent ischaemic event

Impaired transcranial Doppler ultrasound cerebrovascular reactivity before carotid intervention is not predictive of a subsequent ischaemic event

Cerebral Hemodynamics and Metabolism in Patients With Symptomatic Occlusion of the Internal Carotid Artery

Evaluation of Shunt Use with Near Infrared Spectroscopy During Carotid Endarterectomy: An Observational Clinical Study

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