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Evaluation of Vasomotor Reactivity by Transcranial Doppler Sonography in Patients With Acute Stroke Who Have Symptomatic Intracranial and Extracranial Stenosis

Department of Neurology, University of Trakya, School of Medicine, Edirne, Turkey.

Address correspondence to Talip Asil, Department of Neurology, University of Trakya, School of Medicine, Güllapoglu Yerleskesi, 22030 Edirne, Turkey. E-mail: talip_asil{at}yahoo.com

Objective. In patients with large artery disease, determining the cerebral hemodynamic state and following its alterations may be a good marker for predicting long-term outcome. The aim of our study was to compare the changes in vasomotor reactivity (VMR) of patients with symptomatic intracranial and extracranial artery stenosis. We also examined whether VMR after stroke influences the long-term prognosis for these patients. Methods. Forty-one patients were included in the study. To determine the cerebral hemodynamic state, transcranial Doppler ultrasound examinations and acetazolamide tests were performed after acute stroke and repeated after 6 months. We compared the VMR on admission and at 6 months, together with changes in VMR, of the patients with symptomatic intracranial and extracranial artery stenosis. By calculating the Barthel index at 6 months, we examined whether VMR had an effect on an improvement in their quality of life. Results. We observed a significantly higher initial VMR of the ipsilateral hemisphere in patients with intracranial stenosis (22.4 ± 9.1 versus 13.4 ± 12.8; P = .013). At 6 months, the VMR obtained from the ipsilateral hemisphere was better in patients with extracranial stenosis than in the patients with intracranial stenosis (P = .01). The ipsilateral VMR measured on admission showed a positive correlation with the Barthel index at 6 months (P = .007; r = 0.434). Conclusions. Our study showed that VMR in patients with acute stroke who have extracranial and intracranial artery stenosis measured by using a transcranial Doppler examination may have value in predicting long-term outcome.

Key Words: large artery atherothrombosis • transcranial Doppler examination • vasomotor reactivity

Abbreviations: BI, Barthel index • CBF, cerebral blood flow • DBFV, diastolic blood flow velocity • ICA, internal carotid artery • MBFV, mean blood flow velocity • MCA, middle cerebral artery • PET, positron emission tomography • SBFV, systolic blood flow velocity • SPECT, single-photon emission computed tomography • TCD, transcranial Doppler • VMR, vasomotor reactivity