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Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow
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Functional Transcranial Doppler Ultrasound for Monitoring Cerebral Blood Flow

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A transcranial Doppler study of basilar hemodynamics in progressive carotid artery disease

R W Keunen1, D L Tavy, H F Visée

  • 1Department of Neurology and Clinical Neurophysiology, Leyenburg Hospital, Hague, The Netherlands.

Neurological Research
|August 26, 1998
PubMed

Insights

In carotid artery disease, the basilar artery (BA) can be a crucial collateral. However, its function is impaired in severe bilateral disease, increasing stroke risk.

Area of Science:

  • Neurology
  • Vascular Neurology
  • Cerebrovascular Disease

Background:

  • Carotid artery disease (CAD) can lead to hypoperfusion in middle cerebral artery (MCA) territories.
  • The basilar artery (BA) may serve as a critical intracranial collateral pathway in such cases.
  • Understanding BA hemodynamics is vital for assessing collateral function and stroke risk.

Purpose of the Study:

  • To investigate the hemodynamic behavior of the basilar artery (BA) in relation to middle cerebral artery (MCA) perfusion status in patients with carotid artery disease (CAD).
  • To assess the role of the BA as an intracranial collateral in maintaining MCA perfusion.
  • To determine the impact of bilateral hemodynamic compromise on BA function and cerebrovascular reactivity (CVR).

Main Methods:

  • Transcranial Doppler (TCD) studies were performed in 40 patients with progressive MCA hypoperfusion due to CAD.
  • Blood flow velocities (BFV), pulsatility indices (API), and cerebrovascular reactivity (CVR) of the BA and MCA were assessed.
  • Severity of CAD was diagnosed using duplex studies, and MCA hypoperfusion was identified via vasoparalysis during a Diamox procedure.

Main Results:

  • In progressive CAD, basilar artery BFV increased, and PI decreased, while CVR remained unchanged, indicating collateral function.
  • In cases of bilateral significant CAD with exhausted MCA territory CVR, the BA showed no increased BFV or decreased PI.
  • Under these bilateral conditions, basilar artery CVR significantly decreased, suggesting impaired collateral capacity and exhausted hemodynamics.

Conclusions:

  • Basilar artery CVR is preserved when functioning as an intracranial collateral in unilateral CAD.
  • In bilateral hypoperfused MCA territories, the basilar artery may fail as a collateral pathway.
  • Declining basilar artery CVR in severe bilateral disease reflects exhausted hemodynamics and may indicate an elevated stroke risk in distal BA supply areas.

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