Skip to main content
Log in

Sequential change of hemodynamic reserve in patients with major cerebral artery occlusion or severe stenosis

  • Diagnostic Neuroradiology
  • Published:
Neuroradiology Aims and scope Submit manuscript

Summary

To identify regional vasodilatory capacity and its sequential change, we evaluated prospectively a total of 78 acetazolamide tests in 51 patients with occlusion or greater than 75% stenosis of the carotid or middle cerebral arteries. The relative distribution of cerebral blood flow was determined by single photon emission computed tomography usingN-isopropyl-p-[123I]-iodoamphetamine before and after intravenous injection of acetazolamide. Reduced vasodilatory capacity was demonstrated in 20 patients (38%), including 5 patients with hemodynamic transient ischemic attacks or infarction. Follow-up acetazolamide tests revealed asymptomatic progression of the arterial lesion (from stenosis to occlusion) in 1 patient and almost complete improvement of vasodilatory capacity in 5 patients, including 3 without surgical intervention. During an average follow-up period of 18.5 months, 4 patients died from cardiac causes or neoplasm; no neurovascular events occurred. Much larger numbers of patients with longer observation periods will be necessary to clarify the contribution of chronic hemodynamic failure to subsequent stroke. However, the present data indicate that the acetazolamide test is useful for assesssing the course of high grade stenosis or occlusion of major cerebral arteries.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Herold S, Brown M, Frackowiak RSJ, Mansfield AO, Thomas DJ, Marshall J (1988) Assessment of cerebral haemodynamic reserve: correlation between PET parameters and CO2 reactivity measured by the intravenous 133xenon injection technique. J Neurol Neurosurg Psychiatry 51: 1045–1050

    Google Scholar 

  2. Gibbs JM, Wise RJS, Leenders KL, Jones T (1984) Evaluation of cerebral perfusion reserve in patients with carotid-artery occlusion. Lancet II: 310–314

    Google Scholar 

  3. Gibbs JM, Wise RJS, Thomas DJ, Mansfield AO, Ross Russet RW (1987) Cerebral haemodynamic changes after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 50: 140–150

    Google Scholar 

  4. Powers WJ, Temple LW, Grubb RLJR (1989) Influence of cerebral hemodynamics on stroke risk: one-year follow-up of 30 medically treated patients. Ann Neurol 25: 325–330

    Google Scholar 

  5. Powers WJ, Robert L, Grubb RL Jr, Raichle ME (1989) Clinical results of extracranial-intracranial bypass surgery in patients with hemodynamic cerebrovascular disease. J Neurosurg 70: 61–67

    Google Scholar 

  6. Vorstrup S, Engel HC, Lindewald H, Lassen NA (1984) Hemodynamically significant stenosis of the internal carotid artery treated with endarterectomy. Case report. J Neurosurg 60: 1070–1075

    Google Scholar 

  7. Vorstrup S, Brun B, Lassen NA (1986) Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery. Stroke 17: 1291–1298

    Google Scholar 

  8. Sullivan H, Kingsburg TB, Morgan ME, Jeffcoat RD, Allison JD, Goode JJ, McDonnel DE (1987) The rCBF response to diamox in normal subjects and cerebrovascular disease patients. J Neurosurg 67: 525–534

    Google Scholar 

  9. Schroeder T, Sillesen H, Engell HC (1987) Hemodynamic effect of carotid endarterectomy. Stroke 18: 204–209

    Google Scholar 

  10. Rogg J, Rutigliano M, Yonas H (1989) The acetazolamide challenge: imaging technique to evaluate cerebral blood flow reserve. AJNR 10: 803–810

    Google Scholar 

  11. Winchell HS, Horst WD, Braum L, Oldendorf WH, Hattner R, Parker H (1980) N-isopropyl-[123I]-iodoamphetamine: singlepass brain uptake and wash out; binding to brain synaptosomes; and localization in dog and monkey brain. J Nucl Med 21: 947–952

    Google Scholar 

  12. Moretti JL, Cinotti L, Cesaro P, Defer G, Joulin Y, Segent A, Rapin NV Jr, Raynaud C (1987) Amines for brain tomoscintigraphy. Nucl Med Commun 8: 581–595

    Google Scholar 

  13. Yamaguchi T, Minematsu K, Choki J, Ikeda M (1984) Clinical and neuroradiological analysis of thrombotic and embolic cerebral infarction. Jpn Circ J 48: 50–58

    Google Scholar 

  14. Caplan LR, Sergay S (1976) Positional cerebral ischemia. J Neurol Neurosurg Psychiatry 39: 385–391

    Google Scholar 

  15. Bogousslavsky J, Regli F (1983) Delayed TIAs distal to bilateral occlusion of carotid arteries — evidence for embolic and hemodynamic mechanism. Stroke 14: 58–61

    Google Scholar 

  16. Somerville ER (1984) Orthostatic transient ischemic attacks; a symptom of large vessel occlusion. Stroke 15: 1066–1067

    Google Scholar 

  17. Barnett HJM (1978) Delayed cerebral ischemic episodes distal to occlusion of major cerebral arteries. Neurology 28: 769–774

    Google Scholar 

  18. Barnett HJM, Peerless SJ, Kaufmann JCE (1987) “Stump” of the internal carotid artery — a source for further cerebral embolic ischemia. Stroke 9: 448–456

    Google Scholar 

  19. Countee RW, Vijayanathan T (1979) External carotid artery in internal carotid artery occlusion. Angiographic, therapeutic and prognostic considerations. Stroke 10: 450–460

    Google Scholar 

  20. Countee RW, Vijayanathan T, Chavis P (1981) Recurrent retinal ischemia beyond cervical carotid occlusions. Clinical-angiographic correlations and therapeutic implications. J Neurosurg 55: 532–542

    Google Scholar 

  21. Bogousslavsky J, Regli F, Hungerbuhler JP, Chrzanowski R (1981) Transient ischemic attacks and external carotid artery: retrospective study of 23 patients with an occlusion of the internal carotid artery. Stroke 12: 627–630

    Google Scholar 

  22. Ross Russell RW, Page NRG (1980) Critical perfusion of brain and retina. Brain 106: 419–434

    Google Scholar 

  23. Baron JC, Bousser MG, Rey A, Guilard A, Comar D, Castaigne P (1981) Reversal of focal “misery-perfusion syndrome” by extra-intracranial bypass in hemodynamic cerebral ischemia. Stroke 12: 454–459

    Google Scholar 

  24. Stark RJ, Wodak J (1983) Primary orthostatic cerebral ischemia. J Neurol Neurosurg Psychiatry 46: 883–891

    Google Scholar 

  25. Ruff R, Rolman WT, Petito F (1981) Transient ischemic attacks associated with hypotension in hypertensive patients with carotid artery stenosis. Stroke 12: 353–355

    Google Scholar 

Download references

Author information

Authors and Affiliations

Authors

Rights and permissions

Reprints and permissions

About this article

Cite this article

Hasegawa, Y., Yamaguchi, T., Tsuchiya, T. et al. Sequential change of hemodynamic reserve in patients with major cerebral artery occlusion or severe stenosis. Neuroradiology 34, 15–21 (1992). https://doi.org/10.1007/BF00588426

Download citation

  • Received:

  • Issue Date:

  • DOI: https://doi.org/10.1007/BF00588426

Key words

Navigation