Document Detail

The course of dynamic cerebral autoregulation during cervical internal carotid artery occlusion.
MedLine Citation:
PMID:  22080992     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVES: The selection of patients with cervical internal carotid artery occlusion (ICAO) for extracranial-intracranial bypass surgery is based on exhausted cerebrovascular reactivity to vasodilatory stimuli. However, a spontaneous increase in this reactivity can occur with time, questioning the ideal time for bypass surgery. In contrast, the natural course of dynamic cerebral autoregulation is not known in these patients.
METHODS: Patients with cervical ICAO were examined at baseline and after a mean interval of 15 months. Dynamic autoregulation was determined by transcranial Doppler sonography in both middle cerebral arteries via respiratory-induced 0·1-Hz oscillations (phase, available for n=47 patients) and correlation analysis between diastolic blood pressure and Doppler signal (index Dx, n=55 patients). Pre-defined cut-off values and repeatability measures of healthy controls were used to define significant individual changes in autoregulation.
RESULTS: Group mean comparisons between studies were not significant for any autoregulation parameter. The intraclass correlation coefficient between studies was high for phase (ipsilateral: 0·83; contralateral: 0·74), and moderate for Dx (ipsilateral: 0·63; contralateral: 0·35). There was no clear trend for an improvement across cut-off values. A significant individual improvement/deterioration in autoregulation occurred in 6%/6% for phase and 13%/9% for Dx.
DISCUSSION: Dynamic autoregulation only rarely improves during the course of ICAO. This finding should be considered when deciding for or against a policy of delaying extracranial-intracranial bypass surgery for reasons of a potentially improving hemodynamic status.
Matthias Reinhard; Markus Roth; Brigitte Guschlbauer; Marek Czosnyka; Jens Timmer; Cornelius Weiller; Andreas Hetzel
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Neurological research     Volume:  33     ISSN:  1743-1328     ISO Abbreviation:  Neurol. Res.     Publication Date:  2011 Nov 
Date Detail:
Created Date:  2011-11-14     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7905298     Medline TA:  Neurol Res     Country:  England    
Other Details:
Languages:  eng     Pagination:  921-6     Citation Subset:  IM    
University of Freiburg, Germany.
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