RT Journal Article
SR Electronic
T1 The effect of diagnostic hypercapnic cerebrovascular reactivity imaging on vital signs and acute and follow-up ischemic adverse events in patients with flow-limiting intracranial arterial stenosis
JF American Journal of Neuroradiology
JO Am. J. Neuroradiol.
FD American Society of Neuroradiology
SP ajnr.A8714
DO 10.3174/ajnr.A8714
A1 Leguizamon, Melanie
A1 Han, Caleb
A1 Garza, Maria
A1 Horne, Mackenzie
A1 Richerson, Wesley T.
A1 Davis, L. Taylor
A1 Martin, Dann
A1 Fusco, Matthew
A1 Chitale, Rohan
A1 Jordan, Lori C.
A1 Donahue, Manus J.
YR 2025
UL http://www.ajnr.org/content/early/2025/02/24/ajnr.A8714.abstract
AB BACKGROUND AND PURPOSE: Anatomical imaging is a hallmark for visualizing chronic and acute infarcts but provides incomplete information on stroke risk. Respiratory hypercapnic gas challenges show promise for non-invasively assessing hemodynamic function and mapping cerebrovascular reserve capacity, an indicator of how near parenchyma is to exhausting autoregulatory capacity. However, limited safety information exists for this method in high-risk patients with flow-limiting stenosis. This study reports on the physiological changes and adverse events (AEs) following diagnostic hypercapnic cerebrovascular reactivity imaging assessments.MATERIALS AND METHODS: Between January 2011 and May 2024, reactivity scans were performed on 262 patients. In patients with flow-limiting intracranial arterial steno-occlusion (>70%), vital signs were assessed during a twice-repeated three-minute fixed-inspired 5%CO2/95%O2 stimulus, and acute (0–24 hours), sub-acute (24 hours – 2 months), and longer-term (2 – 12 months) AEs were recorded.RESULTS: 129 patients met criteria for flow-limiting arterial steno-occlusion. Blood pressure did not change (p>0.40) with hypercapnia. EtCO2 (baseline:36.5±4.5 mmHg, hypercapnia:42.5±3.8 mmHg) and SaO2 (baseline:97.5±1.8%, hypercapnia:99.4±0.8%) increased (p<0.001), paralleling hypercapnic-hyperoxic physiology. No acute ischemic adverse events were noted. One sub-acute and four long-term neurological events were noted, within expected range for this population.CONCLUSIONS: Findings support using hypercapnic reactivity mapping in the setting of flow-limiting cerebrovascular disease.ABBREVIATIONS: CVR = cerebrovascular reactivity, MRI = magnetic resonance imaging, EtCO2 = end-tidal carbon dioxide, SaO2 = arterial oxygen saturation, BOLD = blood oxygenation level-dependent, AE = adverse event, SAE = serious adverse event