Cerebral arterial compliance in patients with internal carotid artery disease

E. Carrera, Dong Ju Kim, G. Castellani, C. Zweifel, P. Smielewski, J. D. Pickard, P. J. Kirkpatrick, M. Czosnyka

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

Background: A decrease in arterial compliance of the internal carotid artery has been associated with an increased risk in ipsilateral ischaemic stroke. However, so far, no technique has been validated to monitor the compliance of intracerebral arteries (Ca) in patients with carotid artery disease. In this study, we sought to monitor Ca in patients with unilateral symptomatic disease and to determine its variations during changes in PaCO 2. Methods: We studied 18 patients with unilateral symptomatic internal carotid artery stenosis >50% or occlusion. Patients underwent monitoring of arterial blood pressure (ABP) and middle cerebral artery cerebral blood flow velocities (CBFV) during baseline, hyperventilation and 5%CO 2 inhalation. Ca was calculated from pulsatile amplitudes of ABP and Cerebral arterial blood volume, extracted from the CBFV waveform using a new mathematical model. Results: At baseline, the decrease in Ca on the diseased side was correlated with the degree of stenosis (r=-0.35; P=0.01). During hypocapnia, Ca was lower compared to baseline on the normal side (P=0.004) and on the diseased side (P=0.04). Ca reactivity, reflecting the changes in Ca per changes in 1mmHg PaCO 2, was lower on the diseased side between baseline and hypocapnia (3.4 vs. 2.6%; P=0.04). During hypercapnia, no changes in Ca on the diseased (P=0.8) nor on the normal sides (P=0.2) were observed. Conclusions: The decrease in cerebral arterial compliance the side of stenosis/occlusion was correlated with the severity of the internal carotid artery disease. Further studies are needed to determine whether Ca may improve the prediction of ischaemic events in symptomatic and asymptomatic patients.

Original languageEnglish
Pages (from-to)711-718
Number of pages8
JournalEuropean Journal of Neurology
Volume18
Issue number5
DOIs
Publication statusPublished - 2011 May 1
Externally publishedYes

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Carotid Artery Diseases
Patient Compliance
Cerebrovascular Circulation
Compliance
Hypocapnia
Blood Flow Velocity
Arterial Pressure
Pathologic Constriction
Hyperventilation
Hypercapnia
Carotid Stenosis
Middle Cerebral Artery
Physiologic Monitoring
Internal Carotid Artery
Carbon Monoxide
Inhalation
Theoretical Models
Arteries
Stroke

Keywords

  • Arterial compliance
  • Carotid artery disease
  • Cerebrovascular reactivity
  • Transcranial doppler

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Carrera, E., Kim, D. J., Castellani, G., Zweifel, C., Smielewski, P., Pickard, J. D., ... Czosnyka, M. (2011). Cerebral arterial compliance in patients with internal carotid artery disease. European Journal of Neurology, 18(5), 711-718. https://doi.org/10.1111/j.1468-1331.2010.03247.x

Cerebral arterial compliance in patients with internal carotid artery disease. / Carrera, E.; Kim, Dong Ju; Castellani, G.; Zweifel, C.; Smielewski, P.; Pickard, J. D.; Kirkpatrick, P. J.; Czosnyka, M.

In: European Journal of Neurology, Vol. 18, No. 5, 01.05.2011, p. 711-718.

Research output: Contribution to journalArticle

Carrera, E, Kim, DJ, Castellani, G, Zweifel, C, Smielewski, P, Pickard, JD, Kirkpatrick, PJ & Czosnyka, M 2011, 'Cerebral arterial compliance in patients with internal carotid artery disease', European Journal of Neurology, vol. 18, no. 5, pp. 711-718. https://doi.org/10.1111/j.1468-1331.2010.03247.x
Carrera, E. ; Kim, Dong Ju ; Castellani, G. ; Zweifel, C. ; Smielewski, P. ; Pickard, J. D. ; Kirkpatrick, P. J. ; Czosnyka, M. / Cerebral arterial compliance in patients with internal carotid artery disease. In: European Journal of Neurology. 2011 ; Vol. 18, No. 5. pp. 711-718.
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abstract = "Background: A decrease in arterial compliance of the internal carotid artery has been associated with an increased risk in ipsilateral ischaemic stroke. However, so far, no technique has been validated to monitor the compliance of intracerebral arteries (Ca) in patients with carotid artery disease. In this study, we sought to monitor Ca in patients with unilateral symptomatic disease and to determine its variations during changes in PaCO 2. Methods: We studied 18 patients with unilateral symptomatic internal carotid artery stenosis >50{\%} or occlusion. Patients underwent monitoring of arterial blood pressure (ABP) and middle cerebral artery cerebral blood flow velocities (CBFV) during baseline, hyperventilation and 5{\%}CO 2 inhalation. Ca was calculated from pulsatile amplitudes of ABP and Cerebral arterial blood volume, extracted from the CBFV waveform using a new mathematical model. Results: At baseline, the decrease in Ca on the diseased side was correlated with the degree of stenosis (r=-0.35; P=0.01). During hypocapnia, Ca was lower compared to baseline on the normal side (P=0.004) and on the diseased side (P=0.04). Ca reactivity, reflecting the changes in Ca per changes in 1mmHg PaCO 2, was lower on the diseased side between baseline and hypocapnia (3.4 vs. 2.6{\%}; P=0.04). During hypercapnia, no changes in Ca on the diseased (P=0.8) nor on the normal sides (P=0.2) were observed. Conclusions: The decrease in cerebral arterial compliance the side of stenosis/occlusion was correlated with the severity of the internal carotid artery disease. Further studies are needed to determine whether Ca may improve the prediction of ischaemic events in symptomatic and asymptomatic patients.",
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AU - Kim, Dong Ju

AU - Castellani, G.

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AU - Smielewski, P.

AU - Pickard, J. D.

AU - Kirkpatrick, P. J.

AU - Czosnyka, M.

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