Cerebral vasomotor reactivity of bilateral severe carotid stenosis: Is stroke unavoidable?

A. Y. Gur, N. M. Bornstein

Research output: Contribution to journalArticlepeer-review

17 Scopus citations


We evaluated the cerebral hemodynamic features of severe bilateral carotid stenosis by assessing and comparing cerebral vasomotor reactivity (VMR) in the middle cerebral (MCA) and vertebral arteries (VA) by transcranial Doppler and the Diamox (1 g acetazolamide i.v.) test. VMR was evaluated by recording the percentage differences in peak systolic blood flow velocity in each MCA and VA at baseline and by the Diamox test. Twenty-eight symptomatic (SCAS) and 31 asymptomatic (ACAS) patients with bilateral severe (>70%) internal carotid artery stenosis were studied. The mean MCA VMR% was 29 ± 26.9% in SCAS and 43.2 ± 26.8% in ACAS patients (P < 0.01). Their respective mean VA VMR% was 30.2 ± 36.5% and 39.6 ± 24.4% (P = NS). VMR% of the symptomatic MCA side in SCAS patients was significantly lower than the opposite side (20.5 ± 31.1% and 39.2 ± 37.9% respectively; P < 0.03). In contrast, the VA VMR% of both sides in SCAS patients remained similar (28.1 ± 39.3% and 34.6 ± 47.9% respectively; P = NS). VMR% of the MCA and VA in ACAS patients was also similar for both sides of bilateral carotid stenosis. The cerebral hemodynamic features differ between SCAS and ACAS patients with bilateral carotid occlusive disease in the anterior part of the circle of Willis. An independent cerebral vascular reserve capacity of the posterior circulation is proposed.

Original languageEnglish
Pages (from-to)183-186
Number of pages4
JournalEuropean Journal of Neurology
Issue number2
StatePublished - 1 Feb 2006
Externally publishedYes


  • Acetazolamide
  • Carotid stenosis
  • Circle of Willis
  • Doppler
  • Middle cerebral artery
  • Transcranial
  • Ultrasonography
  • Vasomotor reactivity
  • Vertebral artery

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology


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