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      Vasomotor reactivity in middle cerebral artery stenosis.

      Journal of the Neurological Sciences

      physiopathology, Vasomotor System, physiology, Vasodilation, Vasoconstriction, Ultrasonography, Doppler, Transcranial, epidemiology, Stroke, Single-Blind Method, Middle Aged, Male, Magnetic Resonance Angiography, pathology, Infarction, Middle Cerebral Artery, Hypertension, Hypercapnia, Humans, Female, Diabetes Mellitus, Constriction, Pathologic, Comorbidity, analysis, Carbon Dioxide, Breath Tests, ultrasonography, Arterioles, Aged

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          Abstract

          Vasomotor reactivity (VMR) represents the autoregulatory capacity of cerebral vessels and its clinical significance has been reported in steno-occlusive diseases of internal carotid artery (ICA). However, it has yet to be studied in intracranial steno-occlusive diseases. Consecutive patients with middle cerebral artery (MCA) stenosis diagnosed by MR angiography were compared with age-matched controls. Patients with ipsilateral ICA stenosis or advanced small vessel disease were excluded. Degree of stenosis was graded as mild (< 50%), moderate (50-90%), or severe (> 90%). VMR was measured by a semi-closed rebreathing method with monitoring of end-expiratory CO₂ level and calculated by percentage change of mean flow velocity of MCA. Fifty-eight MCAs with stenosis among 44 patients were compared with 38 MCAs without stenosis among 19 controls. VMR was reduced in patients with stenosis as compared with controls (41.6% vs 57.1%, p < 0.001). VMR was more reduced in patients with previous stroke compared with those without previous stroke (27.5% vs 53.1%, p < 0.001). Decrement of VMR was well correlated with degree of stenosis (p < 0.001). Multivariate logistic regression analysis adjusting for age, hypertension and diabetes revealed moderate to severe stenosis as an independent determinant of reduced VMR (odds ratio 10.2, 95% CI 3.35-30.96, p < 0.001). TCD measurement of VMR is feasible in MCA stenosis and VMR is reduced in a dose-responsive manner. These pilot results need to be replicated and further clinical significance of VMR in MCA stenosis remains to be determined. Copyright © 2010 Elsevier B.V. All rights reserved.

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          Journal
          21112599
          10.1016/j.jns.2010.11.008

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