Cerebrovascular reactivity after treatment of unruptured intracranial aneurysms - a transcranial Doppler sonography and acetazolamide study

• Published in: Journal of the neurological sciences 2016-04, Vol.363, p.97-103
• Main Authors: Bøthun, Marianne Lundervik, Haaland, Øystein Ariansen, Logallo, Nicola, Svendsen, Frode, Thomassen, Lars, Helland, Christian A
• Format: Article
• Language: English
• Subjects: Acetazolamide; Acetazolamide - pharmacology; Acetazolamide - therapeutic use; Adult; Blood flow velocity; Blood Flow Velocity - drug effects; Blood Flow Velocity - physiology; Cerebral hemodynamics; Cerebrovascular Circulation - drug effects; Cerebrovascular Circulation - physiology; Cerebrovascular reactivity; Female; Humans; Intracranial aneurysm; Intracranial Aneurysm - diagnostic imaging; Intracranial Aneurysm - drug therapy; Intracranial Aneurysm - physiopathology; Male; Middle Aged; Neurology; Prospective Studies; Transcranial Doppler sonography; Treatment Outcome; Ultrasonography, Doppler, Transcranial - methods
• ISSN: 0022-510X; 1878-5883
• DOI: 10.1016/j.jns.2015.12.024

Abstract Background Cerebrovascular reactivity (CVR) is defined as the change in cerebral blood flow, or blood velocity, in response to a vasoactive stimulus. There is a possible association between impaired CVR and vasospasm after aneurysmal subarachnoid hemorrhage. Most studies on CVR and vasospasm have used healthy subjects as reference. However, due to potential different vascular features, CVR in persons with intracranial aneurysms may differ from CVR in healthy subjects. Therefore, our aim was to examine CVR in patients with unruptured intracranial aneurysms (UIA). Methods CVR was examined in 37 patients in the first postoperative week after treatment for UIA, using acetazolamide (AZ) test with transcranial Doppler monitoring of blood flow velocities. Results Mean blood flow velocity in the middle cerebral arteries was 58.5 (SD 12.8) cm/s at baseline, and 94.3 (SD 19.5) cm/s after stimulation with AZ. Mean CVR was 62.6 (SD 16.8) %. There was no significant difference when comparing right and left sides, and treated and untreated sides. A simple regression analysis suggested that CVR increased with 0.7% points for each year a patient aged (p = 0.004). However, the significance disappeared in a multiple analysis (increase of 0.6% points per year, p = 0.055). Other possible influencing factors (gender, smoking, hypertension, body mass index, aneurysm location and treatment modality) were not significantly associated with CVR. Conclusions CVR in patients with UIA is not different from normal values reported in healthy subjects, and does not indicate a systemically impaired vascular system in patients with UIA. We suggest that CVR in age and gender matched healthy controls can be used as reference for persons with intracranial aneurysms.