Chapter 3 and CVR in such a patient group seems to be relevant since multiple studies 13, 14, 16, 18, 19 have shown impaired cerebral autoregulation in patients with lacu- nar stroke. Major aim of our study into cerebrovascular function was to evaluate dCA parameters before and after ACZ infusion to quantify CVR. A sub question was whether dCA is reduced to a non-functional level after ACZ infusion at a dosage normally used for routine diagnostics and expected to test maximal cerebrovas- cular reserve capacity. Eventually, it was questioned whether dCA parameters relate to CVR results. Methods Subjects and measurements The study group consisted of 29 subjects (19M/10F, median age 67 ranging from 40 to 80 yrs) who suffered a first ever lacunar stroke. Lacunar stroke is defined as an acute stroke syndrome with an MRI finding compatible with the patient’s clinical status. This in combination with either a T2-weighted hyperintense subcortical lesion smaller than 20 mm in diameter or an acute stroke syndrome compatible with one of the lacunar syndromes in the absence of such MRI lesion 2. The Institutional Review Board approved the study and all subjects gave written informed consent. Patients with a stenosis of the common or internal carotid artery or the MCA of more than 50%, as detected by extracranial or transcranial color-coded duplex, were excluded. The electrocardiogram (ECG) and non-invasive ABP were measured using a Task Force Monitor (CN Sys- tems®, Austria). A transcranial Doppler system (Multidop X4, DWL®, Sip- plingen, Germany) was used to measure CBFV in the main stem of both the right and left MCA. Two 2 MHz-probes were held in position by a special frame. Patients were in supine position during all recordings. Dynamic cerebral autoregulation was investigated before and after the admini- stration of ACZ, which was adjusted to body weight (15 mg/kg). The ACZ was dissolved in water in a concentration of 100 mg/ml. The infusion was performed at a speed of 1 ml/min. Before the ACZ infusion was started, a measurement lasting at least five minutes was performed. Then ACZ was administered which on average lasted 10 minutes. Upon finishing ACZ infusion the measurement was continued for at least another 10 minutes until a steady state was reached. DCA data were analyzed separately for pre- and post-ACZ infusion. 46
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