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A Journal on Angiology

Official Journal of the International Union of Angiology, the International Union of Phlebology and the Central European Vascular Forum
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International Angiology 2002 September;21(3):256-9


language: English

Testing of cerebral endothelium function with L-arginine after stroke

Zvan B., Zaletel M., Pogacnik T., Kiauta T.

Department of Neuoradiology, University Medical Center Ljubljana, Ljubljana, Slovenia


Background. Endothelium-depen­dent vas­o­dil­a­ta­tion could be ­impaired dur­ing hypo­per­fu­sion. L-argi­nine (L-A), a pre­cur­sor of ­nitric oxide, is able to elic­it endo­the­li­um-depen­dent vas­o­dil­a­ta­tion. To deter­mine cere­bral vas­cu­lar endo­the­lial func­tion in the early stag­es after ischem­ic ­stroke, we stud­ied cereb­ro­vas­cu­lar reac­tiv­ity to L-A with trans­cra­ni­al Doppler (TCD).
Methods. The study group con­sist­ed of 15 ­patients with the mid­dle cere­bral ­artery syn­drome, aged 57.6±9.8 years. They were inves­ti­gat­ed on days 7 to 10 after ischem­ic ­stroke. The con­trol group con­sist­ed of 15 ­healthy vol­un­teers, aged 58±10.7 years. All sub­jects ­received an intra­ve­nous infu­sion of L-A over 20 min­ at a rate of 1.5 g/min. The mean arte­ri­al veloc­ity (vm) was meas­ured in both mid­dle cere­bral arter­ies by using a bitem­po­ral mon­i­tor­ing ­system (Multi-Dop X4, DWL). At the same time, the mean arte­ri­al pres­sure (MAP) and heart rate (HR) were meas­ured by Finapres and ECG. The end-tidal CO2 (Et-Co2) was mon­i­tored by cap­no­graph. The Vm over 5-min inter­vals at rest and dur­ing the infu­sion of L-A was deter­mined by using the DWL TCD8 soft­ware.
Results. The Vm sig­nif­i­cant­ly ­increased in both hem­i­spheres of both ­groups (p=0.00). Vm dif­fer­enc­es ­between rest and L-A stim­u­la­tion were lower in the ischem­ic hem­i­spheres com­pared to the ­healthy ones (p=0.00), but did not dif­fer ­between the ischem­ic hem­i­spheres and hem­i­spheres of the ­healthy group (p>0.05). MAP, HR and Et-Co2 did not ­change dur­ing the infu­sion (p>0.05).
Conclusions. Cerebrovascular reac­tiv­ity to L-A is ­impaired in ­patients with ­recent ­stroke. The amino acid could thus be use­ful in test­ing endo­the­li­um func­tion both in ­healthy per­sons and in ­stroke ­patients since endo­the­li­um dys­func­tion seems to be an impor­tant fac­tor in reper­fu­sion inju­ry.

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