Stress test with physical activity: features of hemodynamics and kinetics of carotid arteries in atherosclerotic stenosis

Abstract

Aim. To analyze the effect of exercise on cerebral hemodynamics in borderline ste­­nosis of internal carotid artery (ICA) (40-69%) in asymptomatic patients.Material and methods. The study included 120 patients: group I (n=40) — without signs of carotid bifurcation atherosclerosis; II (40) — with hemo­dynamically insignificant stenosis of ICA (40-69%): IIA — with ICA stenosis of 40-59% (18); IIB — 60-69% (22); III (40) — with hemodynamically significant stenosis of ICA (≥70%, without occlusion). All patients underwent following investigations: blood coagulation and lipid profile tests; doppler ultrasound of extracranial vessels, sphygmography of the common carotid artery (CCA), brain computed tomography, transcranial doppler ultrasound, cycle ergometer stress echocardiography with determination of ICA stenosis hemo­dynamics.Results. In most (29 (72,5%)) patients of group II, stress test revealed a de­crease in ICA flow, CCA kinetics according to sphygmography compared with group I, as well as a direct correlation between the degree of stenosis and a blood flow decrease. The indicators approached the data of group III patients.Conclusion. With stenosis of the ICA (40-69%), when a submaximal heart rate (HR) is reached, a functional hemodynamically significant stenosis of the ICA develops. An additional indication for carotid endarterectomy is a combination of 40-69% stenosis and functional hemodynamically significant stenosis when submaximal heart rate is reached. Patients with ICA stenosis (40-69%) require a stress test to assess functional hemodynamically significant stenosis when submaximal heart rate is reached.