Increase in middle cerebral artery velocity on breath holding: A simplified test of cerebral perfusion reserve

doi:10.1016/S0950-821X(05)80795-9

European Journal of Vascular Surgery

Volume 4, Issue 5, October 1990, Pages 519-523

https://doi.org/10.1016/S0950-821X(05)80795-9 Get rights and content

Resting middle cerebral artery velocity (V_mca) as well as its rate of increase on breath holding was measured on both sides in 11 age matched controls (Group I), in six symptomatic patients with unilateral internal carotid artery occlusion (Group II) and in nine symptomatic patients with unilateral internal carotid stenosis of >75% (Group III), using a transcranial doppler velocimeter. There was a significantly lower resting V_mca in Group II patients on the occluded side, but not on the stenosed side in Group III, but there was considerable overlap of results. However, during breath holding, the rate of increase of V_mca allowed better separation of the occluded side (Group II) from the contralateral normal side as well as from controls, and from the stenosed side in Group III. Also there was a lower rate of rise of V_mca on the stenosed side in Group III than controls. As a test in symptomatic patients with a relevant carotid occlusion, values of <2.4 mm/sec² were found in 100% of patients and only 4.5% of controls. Reactivity to breath holding promises to be a useful test in the evaluation of symptomatic patients with extra cranial carotid artery disease.

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Not all patients can tolerate the breathing-mask, and these patients are often excluded from CO2 breathing studies for CVR measurements. Thus, breath-holding (BH) BOLD fMR imaging is becoming a popular alternative for CVR mapping.19,21,41–43,65–75 BH CVR mapping has been demonstrated to be comparable in CVR assessment to gas inhalation techniques71 and is thus considered reliable.66
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The CVR was estimated in relationship with the increase in the MFV in both MCA during hypercapnia as compared to the resting velocity. BHI is obtained by dividing the percentage increase in the MFV occurring during the BHT by the length of time (seconds) that patients held their breath after a normal inspiration [(MFV at the end of BHT − MFV at rest)/MFV at rest] × 100/seconds of breath-holding (Markus & Harrison, 1992; Ratnatunga & Adiseshiah, 1990). Clinical, biological and cerebral hemodynamic indices are presented as medians and IQR, as for variables with skewed distribution.
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Increase in middle cerebral artery velocity on breath holding: A simplified test of cerebral perfusion reserve

Effect of alterations in the arterial carbon dioxide tension on the blood flow through the cerebral cortex at normal and low arterial pressures

J Neurol Neurosurg Psychiatry

Non invasive transcranial Doppler ultrasound recording of flow velocity in basal cerebral arteries

J Neurosurg

The effect of contrast material, hypercapnia, hyperventilation, hypertonic glucose and papaverine on the diameter of the cerebral arteries-angiographic determination in man

Invest Radio

Dependency of blood flow velocity in the middle cerebral artery on end-tidal carbon dioxide partial pressure. A transcranial ultrasound Doppler study

J Cereb Blood Flow Metab

The effect of altered arterial tensions of carbon dioxide and oxygen on cerebral blood flow and cerebral oxygen consumption of normal young men

J Clin Inv

Effect of internal carotid artery occlusion on middle cerebral artery blood flow at rest and in response to hypercapnia

Lancet