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Cerebrovascular flow-mediated dilation in humans: Methodological challenges, physiological interpretation and future

Yi Zhen Bao1, Tabitha V Craig2, Jenna C McCrone1

  • 1Department of Human Health Sciences, Integrative Cerebrovascular and Environmental Physiology SB Laboratory, University of Guelph, Guelph, Ontario, Canada.

Experimental Physiology
|June 22, 2026
PubMed
Summary

Cerebrovascular flow-mediated dilation (cFMD) measures endothelial function in the carotid artery. This review synthesizes early findings on cFMD mechanisms, methods, and clinical potential for cardiovascular disease risk assessment.

Keywords:
flow‐mediated dilationhypercapniainternal carotid arterynitric oxide

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Area of Science:

  • Cardiovascular Physiology
  • Neurovascular Function
  • Endothelial Biology

Background:

  • Endothelial function is crucial for cardiovascular health, with flow-mediated dilation (FMD) a key biomarker.
  • Ultrasound-based FMD of peripheral arteries is widely used, but cerebrovascular assessment is emerging.
  • Cerebrovascular flow-mediated dilation (cFMD) in the internal carotid artery (ICA) offers a direct measure of cerebral endothelial function.

Purpose of the Study:

  • To review and synthesize current knowledge on cerebrovascular flow-mediated dilation (cFMD).
  • To compare methodologies used for assessing cFMD.
  • To outline future research directions and potential clinical applications of cFMD.

Main Methods:

  • Utilizes hypercapnia (elevated CO2) to increase cerebral blood flow and provoke vasodilation in the internal carotid artery.
  • Employs ultrasound to measure changes in internal carotid artery diameter in response to induced shear stress.
  • Reviews existing literature on cFMD studies investigating various physiological and environmental factors.

Main Results:

  • cFMD is mediated by nitric oxide, similar to peripheral FMD.
  • Early studies show cFMD is influenced by factors like age, sex, and autonomic activity.
  • Some cFMD responses differ from peripheral FMD, highlighting unique aspects of cerebral endothelial regulation.

Conclusions:

  • cFMD is a promising technique for assessing cerebral endothelial function and cardiovascular risk.
  • Further research is needed to standardize methods and explore clinical utility.
  • cFMD may reveal unique insights into cerebrovascular health beyond peripheral measures.