Cerebral Vasoreactivity by Transcranial Doppler and Brain SPECT in Patients with Unilateral Carotid Stenosis

J Korean Neurol Assoc > Volume 23(5); 2005 > Article

Journal of the Korean Neurological Association 2005;23(5): 601-606.

일측 경동맥협착 환자에서 경두개초음파와 단일광자단층촬영을 이용한 뇌혈관 반응도의 평가

김진규, 심용수a 나정호

인하대학교 의과대학 신경과학교실, 가톨릭대학교 의과대학 신경과학교실a

Cerebral Vasoreactivity by Transcranial Doppler and Brain SPECT in Patients with Unilateral Carotid Stenosis

Jin-Kyu Kim

Department of Neurology, Inha University School of Medicine, Incheon; Department of Neurology, Catholic University School of Medicinea, Seoul, Korea

Abstract

Background: Cerebral vasoreactivity (CVR) is known as having insufficient hemodynamic circulation. However, available information for its clinical interpretation is scant. We attempted to find the relationship of CVR with parameters such as stenosis degree and collateral patterns.
Methods: This study was prospectively conducted in 37 patients with more than 50% angiographically proven unilateral carotid stenosis. The relative change of mean flow velocity before and after an acetazolamide challenge was calculated by transcranial Doppler sonography (TCD) and the results were compared with single photon emission computed tomography (SPECT) results. The degree of stenosis and collateral flow patterns were estimated and classified by conventional angiography.
Results: The CVR of middle cerebral artery (MCA) was significantly decreased in the ipsilateral side to the carotid stenosis (p<0.05). The CVR impairment was more severe when symptomatic stenosis was present (p=0.04). There was a significant correlation between the degree of carotid stenosis and the CVR (p<0.01). In the area of impaired CVR by SPECT, the estimated CVR was significantly lower (p<0.05), even to the negative value, implying that there is an actually steal phenomenon in that area.
Conclusions: TCD is a useful tool for the assessment of CVR, which can give diverse clinical information based upon the degree of stenosis. KeyWords:Vasoreactivity, Transcranial Doppler sonography (TCD), Carotid stenosis