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[Assessment of cerebrovascular reserve capacity in patients with carotid artery disease using transcranial Doppler sonography and acetazolamide]. 2000

W Staszkiewicz, and W Antepowicz, and A Gabrusiewicz, and D Gawlikowska
Kliniki Chirurgii Naczyniowej Centrum Medycznego Kształcenia Podyplomowego w Warszawie.

OBJECTIVE In our study we utilised transcranial Doppler sonography (TCD) and the test with intravenously administered acetazolamide (reversible inhibitor of carbonic anhydrase) which causes vasodilatation of the brain resistance vessels to assess cerebrovascular reserve capacity (CVRC) in patients with symptomatic and asymptomatic carotid stenosis. METHODS 25 patients (22 male, 3 female; aged 46-82; mean 62 years) with carotid artery disease were examined. They were qualified for the operation because of that. METHODS Blood flow wave spectrum in the right and left middle cerebral artery (MCA) was analysed. 2 MHz pulsed-wave transducer was placed over the appropriate temporal acoustic window. We measured mean blood flow velocity (Vmean) in both MCAs. The records were taken: a) at rest, b) 15 minutes after 1.0 g of acetazolamide was administered intravenously. Cerebrovascular reserve (CVRC) was calculated as the maximal percentage increase in the appropriate MCA after the administration of acetazolamide in comparison with its value at rest. The values of CVRC were analysed statistically. RESULTS 15 minutes after acetazolamide was injected CVRC was 44 +/- 15% (mean +/- SD) (range 0-74) in asymptomatic hemispheres. In 30 patients (97%) CVRC was 46 +/- 12% (23-74) and in 1 patient (3%) 0% (case nr 7). In the group of symptomatic hemispheres CVRC was 12 +/- 15% (-16-36) after acetazolamide administration. In 12 patients (63%) from this group CVRC was positive: 20 +/- 11% (3-33), in 4 patients (21%) CVRC was 0% (cases nr 8, 9, 22, 23) and in other 3 patients (16%) CVRC was negative: -7 +/- 8 (-16(-)-3) (cases nr 4, 12, 19). CONCLUSIONS 1. The group of patients with symptomatic hemispheres have statistically lower CVRC in comparison with the group of asymptomatic hemispheres. 2. There was no statistical difference between the mean values of CVRC in patients with bilateral, severe carotid stenosis and the ones with unilateral changes. 3. We believe that such a test performed by means of TCD and intravenously injected acetazolamide can indicate a subgroup of patients with carotid stenosis for whom carotid endarterectomy is necessary at the earliest time because of possible early neurological complications appearance which are related to the lack or serious impairment of CVRC.

UI MeSH Term Description Entries
D008297 Male Males
D008875 Middle Aged An adult aged 45 - 64 years. Middle Age
D002257 Carbonic Anhydrase Inhibitors A class of compounds that reduces the secretion of H+ ions by the proximal kidney tubule through inhibition of CARBONIC ANHYDRASES. Carbonate Dehydratase Inhibitor,Carbonate Dehydratase Inhibitors,Carbonic Anhydrase Inhibitor,Carboxyanhydrase Inhibitor,Carboxyanhydrase Inhibitors,Anhydrase Inhibitor, Carbonic,Dehydratase Inhibitor, Carbonate,Inhibitor, Carbonate Dehydratase,Inhibitor, Carbonic Anhydrase,Inhibitor, Carboxyanhydrase,Inhibitors, Carbonate Dehydratase,Inhibitors, Carbonic Anhydrase,Inhibitors, Carboxyanhydrase
D002560 Cerebrovascular Circulation The circulation of blood through the BLOOD VESSELS of the BRAIN. Brain Blood Flow,Regional Cerebral Blood Flow,Cerebral Blood Flow,Cerebral Circulation,Cerebral Perfusion Pressure,Circulation, Cerebrovascular,Blood Flow, Brain,Blood Flow, Cerebral,Brain Blood Flows,Cerebral Blood Flows,Cerebral Circulations,Cerebral Perfusion Pressures,Circulation, Cerebral,Flow, Brain Blood,Flow, Cerebral Blood,Perfusion Pressure, Cerebral,Pressure, Cerebral Perfusion
D005260 Female Females
D006439 Hemodynamics The movement and the forces involved in the movement of the blood through the CARDIOVASCULAR SYSTEM. Hemodynamic
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000086 Acetazolamide One of the CARBONIC ANHYDRASE INHIBITORS that is sometimes effective against absence seizures. It is sometimes useful also as an adjunct in the treatment of tonic-clonic, myoclonic, and atonic seizures, particularly in women whose seizures occur or are exacerbated at specific times in the menstrual cycle. However, its usefulness is transient often because of rapid development of tolerance. Its antiepileptic effect may be due to its inhibitory effect on brain carbonic anhydrase, which leads to an increased transneuronal chloride gradient, increased chloride current, and increased inhibition. (From Smith and Reynard, Textbook of Pharmacology, 1991, p337) Acetadiazol,Acetazolam,Acetazolamide Sodium, (Sterile),Acetazolamide, Monosodium Salt,Ak-Zol,Apo-Acetazolamide,Diacarb,Diamox,Diuramide,Défiltran,Edemox,Glauconox,Glaupax,Huma-Zolamide,Ak Zol,AkZol,Apo Acetazolamide,ApoAcetazolamide,Huma Zolamide,HumaZolamide
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D000369 Aged, 80 and over Persons 80 years of age and older. Oldest Old

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