title: Bilateral vertebral artery disease: transcranial Doppler assessment of the hemodynamic vulnerability to changes in posture.
abstract: Posture changes may cause hemodynamic ischemic events, particularly in severe vertebrobasilar artery disease. It may be difficult and not without risk to prove this vulnerability to changes in posture during angiography. Therefore, TCD monitoring with passive tilting (PT) was used to evaluate cerebral hemodynamics distally to severe bilateral vertebral artery disease (BVAD). PCA flow velocity changes and dynamic cerebral autoregulation (DCA) were analyzed in supine and upright position. Despite a significant autoregulatory deficit distally to BVAD, the posterior cerebral blood supply seemed to be sufficiently maintained as long as systemic blood pressure changes were within normal limits. Posterior cerebral flow velocities, however, were significantly diminished when PT detected a systemic hypotension in upright position. This study proves the feasibility to combine PT and TCD monitoring of the PCA in patients with BVAD. In vertebrobasilar artery disease, the examination of spontaneous and tilt-induced autoregulatory responses could support the evaluation of a risk for hemodynamic ischemia.
authors.affiliation: Department of Neurology, University Hospital Aachen, Aachen, Germany. christina.haubrich@t-online.de
authors.forename: Christina
authors.initials: C
authors.lastname: Haubrich
authors.forename: Alexandra
authors.initials: A
authors.lastname: Kohnke
authors.forename: Christof
authors.initials: C
authors.lastname: Kloetzsch
authors.forename: Walter
authors.initials: W
authors.lastname: Moeller-Hartmann
authors.forename: Rolf R
authors.initials: RR
authors.lastname: Diehl
mesh_terms: D001783:Blood Flow Velocity / Q000502:physiology; D001794:Blood Pressure / Q000502:physiology; D002560:Cerebrovascular Circulation / Q000502:physiology*; D005260:Female; D006339:Heart Rate / Q000502:physiology; D006706:Homeostasis / Q000502:physiology; D006801:Humans; D007024:Hypotension, Orthostatic / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D020769:Posterior Cerebral Artery / Q000503:physiopathology; D011187:Posture / Q000502:physiology*; D016683:Supine Position; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*; D014715:Vertebrobasilar Insufficiency / Q000000981:diagnostic imaging* / Q000503:physiopathology