Document Detail

Cerebral dysautoregulation and the risk of ischemic events in occlusive carotid artery disease.
MedLine Citation:
PMID:  18575926     Owner:  NLM     Status:  MEDLINE    
Dynamic cerebral autoregulation assessed from blood pressure transients can be considerably impaired in severe internal carotid artery (ICA) obstruction. It is unknown whether impaired autoregulation indicates an increased risk of subsequent ischemic events in this situation. 165 patients with ICA stenosis (> 70 %) or occlusion were prospectively followed until anterior circulation stroke, transient ischemic attack, carotid recanalization without prior event, death or study end. Transcranial Doppler sonography was used to determine autoregulation in both middle cerebral arteries from spontaneous blood pressure fluctuations (correlation coefficient indices Dx and Mx) and respiratory- induced 0.1 Hz oscillations (phase). Standard CO(2) reactivity (CO(2)R) was additionally assessed. All indices were classified as impaired vs. preserved according to reference values from 79 agematched controls. During median follow-up of 24.5 months, there were 16 ischemic events over ipsilateral sides. Competing risk analysis revealed a significant predictive effect on ipsilateral ischemic events for impaired Dx (rate ratio 8.2 [95 % confidence interval 1.7-39], p = 0.0079), phase (5.0 [2-13], p = 0.0007) and CO(2)R (9.4 [2.2-40], p = 0.0025). Restricting analysis to severe stenosis alone (n = 103), only impaired phase (rate ratio 8.6 [1.6-45], p = 0.01) remained as a significant predictor. In a continuous statistical model, only Dx and Mx were significant predictors of ischemic events (p = 0.012 and p = 0.016). In conclusion, impaired dynamic cerebral autoregulation indicates an increased risk of subsequent ischemic events in severe obstructive ICA disease. Its clinical application might thus be of help in identifying higher risk patients.
Matthias Reinhard; Thomas A Gerds; Daniel Grabiak; Philipp R Zimmermann; Markus Roth; Brigitte Guschlbauer; Jens Timmer; Marek Czosnyka; Cornelius Weiller; Andreas Hetzel
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2008-06-27
Journal Detail:
Title:  Journal of neurology     Volume:  255     ISSN:  0340-5354     ISO Abbreviation:  J. Neurol.     Publication Date:  2008 Aug 
Date Detail:
Created Date:  2008-12-23     Completed Date:  2009-04-14     Revised Date:  2014-02-19    
Medline Journal Info:
Nlm Unique ID:  0423161     Medline TA:  J Neurol     Country:  Germany    
Other Details:
Languages:  eng     Pagination:  1182-9     Citation Subset:  IM    
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MeSH Terms
Analysis of Variance
Blood Flow Velocity / physiology
Brain / pathology,  physiopathology*
Brain Ischemia / etiology*,  ultrasonography
Carotid Artery Diseases / complications*,  ultrasonography
Case-Control Studies
Cerebrovascular Circulation / physiology*
Follow-Up Studies
Functional Laterality
Middle Aged
Predictive Value of Tests
Reference Values
Regression Analysis
Spectrum Analysis
Ultrasonography, Doppler, Transcranial / methods
Grant Support
G9439390//Medical Research Council

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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