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Updated: Jul 4, 2026
Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow
Published on: March 15, 2021
A Breath-Holding Index Applied to the Internal Carotid Artery Siphon in Transcranial Doppler Studies
Kyu-On Jung1, Seung-Jae Lee1, Tae-Kyeong Lee1
1All authors are from Department of Neurology, Soonchunhyang University Bucheon Hospital, Bucheon, South Korea.
Insights
The breath-holding index using the internal carotid artery siphon (BHIICA) is not a feasible alternative to the middle cerebral artery method (BHIMCA) for assessing cerebrovascular reactivity.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Cerebrovascular reactivity assessment is crucial for managing neurological conditions.
- The breath-holding index (BHI) using middle cerebral artery (MCA) flow velocity (BHIMCA) is a standard method.
- BHIMCA is not feasible in patients with poor temporal windows for transcranial Doppler.
Purpose of the Study:
- To evaluate the feasibility of an alternative BHI method using internal carotid artery (ICA) siphon flow velocity (BHIICA).
- To assess the reproducibility and correlation of BHIICA compared to BHIMCA.
- To investigate the relationship between BHI and internal carotid artery stenosis severity.
Main Methods:
- Prospective study of 24 patients with unilateral or bilateral cervical ICA stenosis.
- Categorization of 48 ICAs into stenosis groups: <50%, 50-99%, and occlusion.
- Comparison of reproducibility and correlation between BHIMCA and BHIICA, and their association with stenosis degree.
Main Results:
- Both BHIMCA and BHIICA demonstrated good reproducibility (intraclass correlation coefficient > 0.9).
- BHIMCA significantly decreased with increasing ICA stenosis (P = .001), while BHIICA did not (P = .952).
- Correlation between BHIMCA and BHIICA was not robust (kappa values: 0.259 right, 0.619 left).
Conclusions:
- BHIICA is not a feasible alternative to BHIMCA for assessing cerebrovascular reactivity.
- The lack of correlation with stenosis severity limits the clinical utility of BHIICA.
- BHIMCA remains the preferred method for cerebrovascular reactivity assessment when feasible.
Background And Purpose:
The breath-holding index (BHI) is a useful method to assess cerebrovascular reactivity. It is calculated based on the mean flow velocities of the middle cerebral artery (MCA) using transcranial Doppler (BHIMCA ). Therefore, it is not feasible in patients with poor temporal windows. This study tested the feasibility of a BHI using the internal carotid artery (ICA) siphon flow velocity (BHIICA ).
Methods:
Twenty-four patients (aged 38-79 years) with unilateral or bilateral stenosis of the cervical ICAs were prospectively recruited. The 48 examined bilateral ICAs were divided into three groups according to the stenosis degree: <50%, 50-99%, and occlusion. We investigated the reproducibility of both BHI methods (BHIMCA and BHIICA ), the correlation between the two BHI methods, and the tendency for the BHIs to decrease with increasing degree of cervical ICA stenosis.
Results:
For the BHIMCA , we found a good reproducibility (intraclass correlation coefficient, rI > .9) and a significantly decreased BHI with increasing stenosis of the ICA (P = .001). For the BHIICA , good reproducibility was demonstrated (rI > or ≒ .9), but there was no significant decrease in the BHI related to the increasing degree of ICA stenosis (P = .952). Furthermore, the correlation between the two BHI methods was not robust (kappa coefficient, right .259; left .619).
Conclusions:
Our study suggests that the BHIICA is not a feasible alternative method to the BHIMCA.
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