Cerebral perfusion pressure and CO2-reactivity in the evaluation of carotid obstructions

In order to evaluate the hemodynamic effect of a carotid artery obstruction, the CO2-reactivity was determined and the systolic carotid artery pressure was measured in 34 patients with a stenosis (20) and/or an occlusion (17) of the internal carotid artery. In 19 patients this was done bilaterally and in 15 unilaterally, a total of 53 observations. A decreased CO2-reactivity was found in 49% (26/53). With a carotid artery blood pressure of less than or equal to 90 mmHg the reactivity Index was diminished in 86% (12/14), with greater than 90 mmHg in 36% (14/39) of cases. It is assumed that in the first mentioned situation the autoregulation tends to be exhausted owing to a fall in perfusion pressure while in the last mentioned the explanation may be ischemic damage or shift of the lower limit of autoregulation towards a higher value as a result of (chronic) hypertension.