Vasodilatory Capacity of the Cerebral Vasculature in Patients with Carotid Artery Stenosis

Bokkers, Reinoud P H; Wessels, Frederik; Worp, H. Bart van der; Zwanenburg, Jaco J.M.; Mali, Willem P.Th.M.; Hendrikse, Jeroen

doi:10.3174/ajnr.a2438

Cited by 21 publications

(18 citation statements)

References 22 publications

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“…A previous study has however demonstrated impairment of the vasodilatory capacity of the cerebral vasculature distal to the ICA stenosis in symptomatic patients. 14 The significantly later onset of the maximum vasodilatory effect in the stenosed ICA of patients in our study also suggests vasodilatory impairment in the more distal cerebral vasculature.…”

Section: Hartkamp Et Al Time Course Of Vascular Reactivity 555supporting

confidence: 61%

Time Course of Vascular Reactivity Using Repeated Phase-Contrast MR Angiography in Patients With Carotid Artery Stenosis

Hartkamp

Hendrikse

Worp

et al. 2012

Stroke

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Background and Purpose-Cerebral vascular reactivity assessment is typically performed with 2 perfusion measurements before and after a vasodilatory challenge. The aim of this study was to assess the time course of the vasodilatory effect in the brain-feeding arteries after a challenge with acetazolamide in patients with a stenosis of the internal carotid artery (ICA). Methods-Twenty-one patients with a symptomatic ICA stenosis and 18 healthy control subjects underwent 2-dimensional phase-contrast MR angiography to repeatedly measure the blood flow (mL/min) in both ICAs at baseline and in 5-minute intervals for 30 minutes after intravenous administration of acetazolamide. Results-At baseline, the blood flow was significantly lower in the stenosed ICAs of patients (155Ϯ17 mL/min) than in the contralateral ICAs (237Ϯ21 mL/min, PϽ0.05) and the ICAs of healthy control subjects (249Ϯ15 mL/min, PϽ0.05) and remained lower throughout the time course. The maximum vasodilatory effect in the stenosed ICAs was observed after 15.3Ϯ0.9 minutes, which was significantly later than in the contralateral ICAs (within 12.9Ϯ0.

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Section: Hartkamp Et Al Time Course Of Vascular Reactivity 555supporting

confidence: 61%

Time Course of Vascular Reactivity Using Repeated Phase-Contrast MR Angiography in Patients With Carotid Artery Stenosis

Hartkamp

Hendrikse

Worp

et al. 2012

Stroke

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“…On the other hand, mild hypoventilation could lead to a steal phenomenon in areas with decreased cerebrovascular reserve. This was observed in patients with high grade carotid artery stenosis where the application of the vasodilative drug acetazolamide mainly dilated vessels in the unaffected brain regions, potentially decreasing cerebral blood flow to hypoperfused areas where vessels are already maximally dilated 18. A similar pathophysiological effect may occur in AIS during hypoventilation related vasodilation.…”

Section: Discussionmentioning

confidence: 84%

Pulmonary and circulatory parameter guided anesthesia in patients with ischemic stroke undergoing endovascular recanalization

Mundiyanapurath

Stehr

Wolf

et al. 2015

J NeuroIntervent Surg

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In patients receiving endovascular stroke treatment under general anesthesia, the cumulative dose of norepinephrine was an independent predictor of an unfavorable outcome. Further studies are needed to evaluate the optimal management of blood pressure in these patients, and whether avoidance of catecholamines could partly explain the improved outcomes for patients treated under conscious sedation in retrospective studies.

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“…Cerebral perfusion of the brain tissue is measured before and after a vasodilatory challenge. Bokkers et al [19] reported that there were no significant increases in vessel diameter in the hemisphere ipsilateral to the symptomatic ICA stenosis, whereas vessel diameter increased significantly in the proximal vasculature of the hemisphere contralateral to the ICA stenosis. Furthermore, the effect of acetazolamide on the side ipsilateral to the stenosis seems to be delayed [20].…”

Section: Introductionmentioning

confidence: 99%

Near-Infrared Transillumination Back Scattering Sounding—New Method to Assess Brain Microcirculation in Patients with Chronic Carotid Artery Stenosis

et al. 2013

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PurposeThe purpose of the study was to assess the responses of pial artery pulsation (cc-TQ) and subarachnoid width (sas-TQ) to acetazolamide challenge in patients with chronic carotid artery stenosis and relate these responses to changes in peak systolic velocity (PSV), cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and time to peak response (TTP).MethodsFifteen patients with carotid artery stenosis ≥90% on the ipsilateral side and <50% on the contralateral side were enrolled into the study. PSV was assessed using colour-coded duplex sonography, CBF, CBV, MTT and TTP with perfusion computed tomography, cc-TQ and sas-TQ with near-infrared transillumination/backscattering sounding (NIR-T/BSS).ResultsBased on the ipsilateral/contralateral cc-TQ ratio after acetazolamide challenge two groups of patients were distinguished: the first group with a ratio ≥1 and the second with a ratio <1. In the second group increases in CBF and CBV after the acetazolamide test were significantly higher in both hemispheres (ipsilateral: +33.0%±8.1% vs. +15.3%±4.4% and +26.3%±6.6% vs. +14.3%±5.1%; contralateral: +26.8%±7.0% vs. +17.6%±5.6% and +20.0%±7.3% vs. +10.0%±3.7%, respectively), cc-TQ was significantly higher only on the ipsilateral side (+37.3%±9.3% vs. +26.6%±8.6%) and the decrease in sas-TQ was less pronounced on the ipsilateral side (−0.7%±1.5% vs. −10.2%±1.5%), in comparison with the first group. The changes in sas-TQ following the acetazolamide test were consistent with the changes in TTP.ConclusionsThe ipsilateral/contralateral cc-TQ ratio following acetazolamide challenge may be used to distinguish patient groups characterized by different haemodynamic parameters. Further research on a larger group of patients is warranted.

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Vasodilatory Capacity of the Cerebral Vasculature in Patients with Carotid Artery Stenosis

Cited by 21 publications

References 22 publications

Time Course of Vascular Reactivity Using Repeated Phase-Contrast MR Angiography in Patients With Carotid Artery Stenosis

Time Course of Vascular Reactivity Using Repeated Phase-Contrast MR Angiography in Patients With Carotid Artery Stenosis

Pulmonary and circulatory parameter guided anesthesia in patients with ischemic stroke undergoing endovascular recanalization

Near-Infrared Transillumination Back Scattering Sounding—New Method to Assess Brain Microcirculation in Patients with Chronic Carotid Artery Stenosis

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