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. 2025 Sep;45(5):e70029.
doi: 10.1111/cpf.70029.

Hemodynamic and autonomic dysfunction in symptomatic carotid artery stenosis

Kristine Wichmann Madsen  1 , Rasmus Primholdt Haahr  2 , Tatevik Mkhitarjan  2 , Niels Wiinberg  2 , Jacob Rørbech Marstrand  1   3 , Sverre Rosenbaum  1 , Alexander Cuculiza Henriksen  2   3 , Lisbeth Marner  2   3   4
Affiliations

Hemodynamic and autonomic dysfunction in symptomatic carotid artery stenosis

Kristine Wichmann Madsen et al. Clin Physiol Funct Imaging. 2025 Sep.

Abstract

Background: Hemodynamic failure in patients with steno-occlusive arterial disease is a major risk factor for stroke. Previous studies have identified impaired autonomic function in patients with carotid artery stenosis. Our study explores autonomic dysfunction and altered cerebrovascular hemodynamics in patients with stenosis and suspected hemodynamic failure.

Methods: To assess autonomic nervous system dysfunction, patients underwent heart rate variability (HRV) testing, an active stand test, and the Valsalva maneuver with simultaneous monitoring of heart rate, blood pressure, and cardiac output. Transcranial Doppler was used to measure relative changes in cerebral blood flow during Valsalva.

Results: Analysis of 13 patients and 19 controls revealed a significantly greater decrease in cerebral blood flow in the patient group during Valsalva, as evidenced by mean relative changes in time-averaged peak velocities ±SE of 0.80 ± 0.04 in patients compared to 0.96 ± 0.05 in controls (p < 0.05). There were no significant differences in mean arterial blood pressure or heart rate during the Valsalva maneuver. HRV analysis and the active stand test did not reveal autonomic dysfunction or orthostatic intolerance.

Conclusion: Patients with steno-occlusive carotid artery disease exhibit impaired intracranial flow during Valsalva-induced blood pressure reduction. However, our results do not support the presence of significant autonomic dysfunction in patients with symptomatic large-vessel cerebrovascular disease as measured by HRV and blood pressure reduction during active stand.

Keywords: autonomic system; brain; cerebrovascular disease; stroke.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Values are shown relative to baseline (mean ± SE) for TAPV, HR, ICR, and MAP (a–d). *p < 0.05: patient group′s symptomatic side compared to the control group (a and b), and patient group compared to the control group (c, d). HR, heart rate; ICR, intracranial vascular resistance; MAP, mean arterial pressure; TAPV, Time‐Averaged Peak Velocity.
Figure 2
Figure 2
ROC curves showing the diagnostic performance of TAPV at 15 s (a), 20 s (b), and maximum flow (c). TAPV, Time‐Averaged Peak Velocity.
See this image and copyright information in PMC

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