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Transcranial Doppler assessment of cerebral perfusion reserve in patients with carotid occlusive disease and no evidence of cerebral infarction

Departments of Neurology (Drs. Chimowitz, Furlan, and Sila), Brain and Vascular Research (Dr. Jones), Radiology (Dr. Lorig), and Biostatistics and Epidemiology (Ms. Paranandi and Dr. Beck), Cleveland Clinic Foundation, Cleveland, OH.

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 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.

Address correspondence and reprint requests to Dr. Marc I. Chimowitz, Department of Neurology, University of Michigan Medical Center, Taubman Center 1324/0322, 1500 E. Medical Center Drive, Ann Arbor, MI 48109.

Supported by a grant from the Cleveland Clinic Foundation.

Presented in part at the 43rd annual meeting of the American Academy of Neurology, Boston, MA, April 1991.

Received March 27, 1992. Accepted for publication in final form June 26, 1992.

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