Impaired Dynamic Cerebral Autoregulation and Cerebrovascular Reactivity in Middle Cerebral Artery Stenosis

PURPOSE: We sought to investigate the capacity of cerebral autoregulation and cerebrovascular reactivity (CVR) in patients with middle cerebral artery (MCA) stenosis. METHODS: 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. RESULTS: 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. CONCLUSION: 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.