Impaired dynamic cerebral autoregulation and cerebrovascular reactivity in middle cerebral artery stenosis.

Abstract

We sought to investigate the capacity of cerebral autoregulation and cerebrovascular reactivity (CVR) in patients with middle cerebral artery (MCA) stenosis. Twenty-one patients with MCA stenosis diagnosed by magnetic resonance angiography and 15 healthy controls were enrolled. Cerebral autoregulation was assessed by autoregulatory parameters (rate of recovery/phase/gain) derived from transfer function from spontaneous oscillations of cerebral blood flow velocity and blood pressure. CVR was tested by a rebreathing maneuver. Rate of recovery, phase and CVR estimated from moderate MCA stenosis (rate of recovery  = 17.76 ± 8.21%/s, phase  = 26.93 ± 15.67°, and CVR  = 1.53 ± 0.84%/mmHg, respectively) were significantly different (p<0.05) from controls (rate of recovery  = 39.62 ± 27.99%/s, phase  = 55.66 ± 22.10°, and CVR = 2.18 ± 0.80%/mmHg, respectively). Rate of recovery (r = -0.698, p<0.001), phase (r = -0.738, p<0.001)) and CVR (r = -0.690, p<0.001) were all significantly correlated with the degree of stenosis. Cerebral autoregulation and CVR were impaired in patients with ≥ 50% MCA stenosis. The measures of both hemodynamic properties were inversely correlated with the stenotic degree.