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Assessment of cerebral autoregulation using carotid artery compression
P Smielewski1, M Czosnyka, P Kirkpatrick
1MRC Cambridge Centre for Brain Repair and Academic Neurosurgical Unit, Addenbrooke's Hospital, University of Cambridge, UK.
Background And Purpose:
A simple method of testing cerebral autoregulation by observing transcranial Doppler changes in middle cerebral artery flow velocity (FV) during a brief ipsilateral carotid artery compression (the transient hyperemic response test) was studied in 11 normal healthy volunteers. The aim of this study was to assess the reliability of the method and to compare derived autoregulatory indices with those of a standard noninvasive test of autoregulation, Aaslid's leg-cuff test.
Methods:
Volunteers were subjected to repeated carotid compressions and leg-cuff tests at different levels of CO2. Hypercapnia was induced using inhalation of a mixture of 5% CO2 in air. Hypocapnia was induced by moderate hyperventilation. To assess the influence of the duration of carotid compression, a series of carotid compressions lasting 3, 4, 5, 7, and 9 seconds were performed in random sequence. Monitored parameters included ipsilateral FV, end-tidal CO2, and arterial blood pressure. The transient hyperemic response ratio (THRR), calculated as the maximum increase of FV divided by baseline values after release of the carotid compression, was taken as the autoregulation index. This index was compared with the rate of autoregulation index derived from the leg-cuff test.
Results:
Both tests were significantly associated with end-tidal CO2 (ANOVA, P < .000001 for both carotid compression and cuff test). There was a linear correlation between THRR and autoregulation index (r = .86). However, the reproducibility of the THRR was more consistent than for the autoregulation index from single tests (13% versus 46%, respectively; P < .0001). Although the influence of the duration of carotid compression on THRR values was significant for carotid compressions lasting up to 5 seconds, there was no relation to the relative magnitude of FV drop during the compression.
Conclusions:
Brief (> 5 seconds) carotid artery compression provides an index of cerebral autoregulation that is reproducible and is affected by CO2 tension in a fashion similar to autoregulatory indices derived from a standard leg-cuff test. The simplicity of the method provides a potentially useful addition to other noninvasive autoregulation tests for clinical assessments, particularly when repeated measurements are required.