Abstract 2762: Asymmetry of The Blood Oxygen Level-Dependent fMRI Response During Hypercapnia Is Reliable to Evaluate Cerebrovascular Reactivity in Patients with Severe Unilateral Carotid Stenosis

Abstract

Background and Purpose: Previous transcranial Doppler studies have suggested that, in patients with severe carotid stenosis, the lack of cerebrovascular reactivity (CVR) is an independent predictor of ipsilateral stroke. The BOLD (Blood Oxygenation Level-Dependent) fMRI contrast can be used to assess the CVR during normal condition and during hemodynamic stress, like hypercapnia. The purpose of this study is to evaluate the BOLD signal parameters on the Middle Cerebral Artery (MCA) territory, induced by auditory stimulus, during different levels of hypercapnia in patients with severe unilateral carotid stenosis, comparing the ipsilateral hemisphere (IH) to the contralateral hemisphere (CH). Methods: The images were obtained from 16 patients with severe unilateral carotid stenosis. Patients were submitted to an auditory stimulus (3s) in three different conditions: normocapnia and at EtCO2 increase of 5 and 10mmHg. The images were acquired with a 3T Philips MR, preprocessed and analyzed using an autoregressive method. Results: The BOLD signal from the IH was different from the CH during the basal condition and at 5mmHg (p<0.0001), but not at the 10mmHg ETCO2 increase. For each BOLD parameter, the major differences between the hemispheres were seen on the onset time (p<0.0001) and amplitude of BOLD signal (p<0.0001). The width difference was significant between the basal and 10mmhHg increase (p<0.01). In these three parameters, the BOLD signal of the IH presented no significant variations with the CO2 increment. However, the BOLD signal for CH showed an increase on the time-to-onset and width and amplitude decrease. The time to peak parameters of the BOLD signal showed no differences between the hemispheres and at hypercapnic conditions. Conclusion: In our results the IH did not respond to the hypercapnic stress as the CH. Therefore, among patients with severe carotid stenosis, BOLD can reliably identify some that have an exhausted CVR, which cannot respond to a vasodilatory stress like hypercapnia. Future studies using this technique may help to select patients for recanalization procedures.