Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation

Reinhard, Matthias; Roth, Markus; Müller, Thomas; Guschlbauer, Brigitte; Timmer, Jens; Czosnyka, Marek; Hetzel, Andreas

Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation

Dateien

Reinhard_271341.pdfGröße: 341.19 KBDownloads: 379

Datum

2004

Autor:innen

Reinhard, Matthias

Roth, Markus

Müller, Thomas

Guschlbauer, Brigitte

Timmer, Jens

Czosnyka, Marek

Hetzel, Andreas

Open Access-Veröffentlichung

Open Access Green

Sammlungen

Philosophie

Publikationstyp

Zeitschriftenartikel

Publikationsstatus

Published

Erschienen in

Stroke. 2004, 35(6), pp. 1381-1387. ISSN 0039-2499. eISSN 1524-4628. Available under: doi: 10.1161/01.STR.0000127533.46914.31

Zusammenfassung

Background and Purpose

Analysis of dynamic cerebral autoregulation (DCA) from spontaneous blood pressure fluctuations might contribute to prognosis of severe internal carotid artery stenosis, but its response to carotid recanalization has not been investigated so far. This study investigates the effect of carotid endarterectomy or stenting on various DCA parameters.

Methods

In 58 patients with severe unilateral stenosis undergoing carotid endarterectomy (n=41) or stenting (n=17), cerebral blood flow velocity (CBFV, transcranial Doppler) and arterial blood pressure (ABP, Finapres method) were recorded over 10 minutes before and on average 3 days after carotid recanalization. Nineteen patients were additionally examined after 7 months. Correlations between diastolic and mean ABP and CBFV fluctuations were averaged to form the correlation coefficient indices (diastolic [Dx] and mean values [Mx]). Transfer function parameters (low-frequency phase and high-frequency gain between ABP and CBFV oscillations) were calculated over the same 10 minutes. CO₂ reactivity was assessed via inhalation of 7% CO₂.

Results

Before recanalization, all DCA parameters were clearly impaired ipsilaterally compared with contralateral sides. Phase, Dx, and Mx indicated early normalization of DCA after both endarterectomy and stenting. By multiple regression, the degree of DCA improvement was highly significantly related to the extent of impairment before recanalization. No significant change in DCA was found at follow-up. Ipsilateral gain and CO₂ reactivity increased significantly less after endarterectomy than after stenting (P<0.05).

Conclusions

Dynamic cerebral dysautoregulation in patients with severe carotid obstruction is readily and completely remedied by carotid recanalization.

Fachgebiet (DDC)

100 Philosophie

Schlagwörter

Blood Flow Velocity, Blood Pressure, Carotid Stenosis, Cerebral Cortex, Endarterectomy, Carotid, Homeostasis, Humans, Male, Middle Aged, Stents

Zitieren

ISO 690

REINHARD, Matthias, Markus ROTH, Thomas MÜLLER, Brigitte GUSCHLBAUER, Jens TIMMER, Marek CZOSNYKA, Andreas HETZEL, 2004. Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation. In: Stroke. 2004, 35(6), pp. 1381-1387. ISSN 0039-2499. eISSN 1524-4628. Available under: doi: 10.1161/01.STR.0000127533.46914.31

BibTex

@article{Reinhard2004-06Effec-27134,
  year={2004},
  doi={10.1161/01.STR.0000127533.46914.31},
  title={Effect of carotid endarterectomy or stenting on impairment of dynamic cerebral autoregulation},
  number={6},
  volume={35},
  issn={0039-2499},
  journal={Stroke},
  pages={1381--1387},
  author={Reinhard, Matthias and Roth, Markus and Müller, Thomas and Guschlbauer, Brigitte and Timmer, Jens and Czosnyka, Marek and Hetzel, Andreas}
}

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