Relationship between transcranial Doppler-determined pulsatility index and cerebrovascular resistance: an experimental study.

Clinical studies with transcranial Doppler suggest that the pulsatility of the flow velocity (FV) waveform increases when the distal cerebrovascular resistance (CVR) increases. To clarify this relationship, the authors studied animal models in which the resistance may be decreased in a controlled manner by an increase in arterial CO2 tension, or by a decrease in cerebral perfusion pressure (CPP) in autoregulating animals. Twelve New Zealand white rabbits were anesthetized, paralyzed, and ventilated. Transcranial Doppler basilar artery FV, laser Doppler cortical blood flow, arterial pressure, intracranial pressure, and end-tidal CO2 concentration were measured continuously. Cerebrovascular resistance (CPP divided by laser Doppler cortical flux) and Gosling Pulsatility Index (PI, defined as an FV pulse amplitude divided by a timed average FV) were calculated as time-dependent variables for each animal. Four groups of animals undergoing controlled manipulations of CVR were analyzed. In Group I, arterial CO2 concentration was changed gradually from hypocapnia to hypercapnia. In Group II, gradual hemorrhagic hypotension was used to reduce CPP. In Group III, the short-acting ganglion blocking drug trimetaphan was injected intravenously to induce transient hypotension. Intracranial hypertension was produced by subarachnoid saline infusion in Group IV. During the hypercapnic challenge the correlation between the cortical resistance and Doppler flow pulsatility was positive (r = 0.77, p<0.001). In all three groups in which cerebral perfusion pressure was reduced a negative correlation between pulsatility index and cerebrovascular resistance was found (r = -0.84, p<0.001). The authors conclude that PI cannot be interpreted simply as an index of CVR in all circumstances.

Shunt audit: a computerized method for testing the performance characteristics of CSF shunts in vitro.

Studies of long-term shunt performance in vivo demonstrate that some 81% fail within 12 years. Such failure is multifactorial in origin: the patient, the surgical technique and the shunt may all prove fallible. Recent studies have shown that there is considerable variability of the performance characteristics of individual shunts when tested for short time periods in relatively simple rigs, and that they do not always behave according to the manufacturers' specifications. We have developed a computerized shunt rig for the long-term evaluation of a valve's performance in vitro using both pressure-flow studies (where flow through the shunt is evaluated for controlled differential pressure across the shunt) and flow-pressure studies (where the differential pressure across the shunt is evaluated for controlled flow rates through the shunt). This rig consists of a pressure transducer, electronic balance, computer-controlled infusion pump and blood pressure systems calibrator that stimulates different wave form patterns. An IBM PC controls all the devices and evaluates the performances characteristics according to various test protocols. Our initial observations with this rig confirm that progressive changes in shunt function occur over long periods of time (weeks).