Complex Characterization of Cerebral Vasoreactivity in Internal Carotid Artery Stenotic Patients With Transcranial Doppler Sonography

Authors

• Hanga Pál, Általános Orvostudományi Kar
• Rita Magyar-Stang, Általános Orvostudományi Kar
• Borbála Csányi, Semmelweis Egyetem
• Anna Gaál, Általános Orvostudományi Kar
• Zsuzsanna Mihály, Semmelweis Egyetem
• Zsófia Czinege, Semmelweis Egyetem
• Péter Sótonyi, Semmelweis Egyetem
• Tamás Horváth, Hungarian University of Sports Science
• Balázs Dobi, HUN-REN-ELTE Motor Pharmacology Research Group
• Dániel Bereczki, Általános Orvostudományi Kar
• Akos Koller, Hungarian University of Sports Science
• Róbert Debreczeni, Általános Orvostudományi Kar

DOI

10.3390/life15111692

Journal Title

Life

Document Type

Article

Publication Date

11-1-2025

Department

Physiology

Keywords

atherosclerosis, carotid artery diseases, cerebral vasoreactivity, transcranial Doppler sonography

Disciplines

Medicine and Health Sciences

Abstract

Background and Aims: Decreased cerebrovascular reactivity (CVR) in patients with significant internal carotid artery stenosis (ICAS ≥ 70%) is an independent risk factor for cerebral infarction. To evaluate CVR, changes in cerebral perfusion pressure and blood flow velocity (BFV) of the middle cerebral artery (MCA) can be estimated by CO2- (hyperventilation—HV and breath-holding—BH) and pressure–flow-based (Common Carotid Artery Compression—CCC and Valsalva Maneuver—VM) stimuli. We used a multimodal approach to characterize CVR in patients before carotid endarterectomy (CEA). Methods: HV, BH, CCC, and VM tests were performed on 31, 26, and 34 patients. BFV of MCAs was monitored by transcranial Doppler, and continuous arterial blood pressure was registered non-invasively. CVR was compared between the operated significantly stenotic and the contralateral sides. Results: The extent of HV- and BH-induced CVR was similar, but the time to the lowest HV-induced BFV was shorter on the side with significant ICAS. The response to CCC was sensitive to hemodynamic asymmetry in the transient hyperemic response ratio and in the cumulative change in the (mean arterial blood pressure)/(mean BFV) ratio. In VM, the slope of BFV increased in the ascending (2b) phase, and the time to overshoot correlated with the side of the stenosis. Conclusions: These results suggest that in patients with significant ICAS, in addition to CO2 reactivity measurements, a more complex estimation of CVR, by using hemodynamic tests (CCC and VM), should also be used to better quantify cerebral ischemic risk.

Recommended Citation

Pál, H., Magyar-Stang, R., Csányi, B., Gaál, A., Mihály, Z., Czinege, Z., Sótonyi, P., Horváth, T., Dobi, B., Bereczki, D., Koller, A., & Debreczeni, R. (2025). Complex Characterization of Cerebral Vasoreactivity in Internal Carotid Artery Stenotic Patients With Transcranial Doppler Sonography. Life, 15 (11). https://doi.org/10.3390/life15111692