title: Transcranial Doppler assessment of cerebral perfusion reserve in patients with carotid occlusive disease and no evidence of cerebral infarction.
abstract: Using transcranial Doppler ultrasound (TCD), we measured bilateral middle cerebral artery mean blood flow velocities (MCAVs) before and 10 minutes after intravenous infusion of 1 gram of acetazolamide in 20 patients without cerebral infarction. Seven patients had normal carotid arteries (group 1), seven had unilateral internal carotid artery (ICA) stenosis > or = 75% (group 2), and six had unilateral ICA occlusion (group 3). Before acetazolamide infusion, side-to-side differences in MCAV were 0.06 cm/sec in group 1 (p = 0.98), 4.3 cm/sec in group 2 (p = 0.36), and 15.0 cm/sec in group 3 (p = 0.02). Bilateral MCAV increased in all three groups after acetazolamide infusion, and the side-to-side differences in MCAV were 3.2 cm/sec in group 1 (p = 0.40), 11.4 cm/sec in group 2 (p = 0.04), and 27.6 cm/sec in group 3 (p = 0.03). Patients with carotid stenosis or occlusion and ipsilateral transient ischemic attacks (TIAs) had higher side-to-side differences in MCAV before (p = 0.03) and after (p = 0.01) acetazolamide than did asymptomatic patients with carotid disease. The association of impaired cerebral perfusion reserve and TIAs suggests that the TCD-acetazolamide test may enable identification of a subgroup of patients with carotid occlusive disease who are at higher risk for stroke.
authors.affiliation: Department of Neurology, Cleveland Clinic Foundation, OH.
authors.forename: M I
authors.initials: MI
authors.lastname: Chimowitz
authors.forename: A J
authors.initials: AJ
authors.lastname: Furlan
authors.forename: S C
authors.initials: SC
authors.lastname: Jones
authors.forename: C A
authors.initials: CA
authors.lastname: Sila
authors.forename: R L
authors.initials: RL
authors.lastname: Lorig
authors.forename: L
authors.initials: L
authors.lastname: Paranandi
authors.forename: G J
authors.initials: GJ
authors.lastname: Beck
mesh_terms: D000086:Acetazolamide / Q000009:adverse effects; D000368:Aged; D001157:Arterial Occlusive Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D001783:Blood Flow Velocity; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D002536:Cerebral Arteries / Q000187:drug effects / Q000503:physiopathology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D014463:Ultrasonography
chemical_list: D000086:Acetazolamide