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Kuroda S, Yamamoto S, Hori E, Kashiwazaki D, Noguchi K. Effects of superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis on the cerebrospinal fluid gas tensions and pH in hemodynamically compromised patients. Acta Neurochir (Wien) 2023; 165:3709-3715. [PMID: 37882875 DOI: 10.1007/s00701-023-05855-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2023] [Accepted: 10/12/2023] [Indexed: 10/27/2023]
Abstract
PURPOSE This study was aimed to directly measure cerebrospinal fluid (CSF) gas tensions and pH before and after STA-MCA anastomosis for occlusive carotid artery diseases to investigate its direct effects on the ischemic brain. METHODS This study included 9 patients who underwent STA-MCA anastomosis on the basis of CBF studies. About 1 mL of CSF was collected before and after bypass procedures, and CSF pH, CSF PO2, and CSF PCO2 were measured with a blood gas analyzer. As the controls, the CSF was collected from 6 patients during surgery for unruptured cerebral aneurysm. CSF PO2 and CSF PCO2 were expressed as the ratio to PaO2 and PaCO2, respectively. RESULTS Before bypass procedure, CSF PO2/PaO2 was 0.88 ± 0.16, being lower than the controls (1.10 ± 0.09; P = 0.005). CSF PCO2/PaCO2 was 0.93 ± 0.13, being higher than the controls (0.84 ± 0.06; P = 0.039). Ipsilateral-to-contralateral CBF ratio had a positive correlation with CSF PO2/PaO2 (P = 0.0028) but a negative correlation with the CSF PCO2/PaCO2 (P = 0.0045). STA-MCA anastomosis increased CSF pH from 7.402 ± 0.133 to 7.504 ± 0.126 (P = 0.0011) and CSF PO2/PaO2 from 0.88 ± 0.16 to 1.05 ± 0.26 (P = 0.018) but decreased CSF PCO2/PaCO2 from 0.93 ± 0.13 to 0.70 ± 0.17 (P = 0.0006). CONCLUSION The severity of cerebral ischemia before surgery is intensely reflected in the gas tensions and pH of the CSF. STA-MCA anastomosis carries dramatic effects on CSF gas tensions and pH in hemodynamically compromised patients. CSF would be a valuable surrogate biomarker to monitor the severity of cerebral ischemia.
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Affiliation(s)
- Satoshi Kuroda
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan.
| | - Shusuke Yamamoto
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Emiko Hori
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Daina Kashiwazaki
- Department of Neurosurgery, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, 2630 Sugitani, Toyama, 930-0194, Japan
| | - Kyo Noguchi
- Department of Radiology, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan
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Sahbai S, Fiz F, Taran F, Brucker S, Wallwiener D, Kupferschlaeger J, La Fougère C, Dittmann H. Influence of 99m-Tc-Nanocolloid Activity Concentration on Sentinel Lymph Node Detection in Endometrial Cancer: A Quantitative SPECT/CT Study. Diagnostics (Basel) 2020; 10:diagnostics10090700. [PMID: 32947918 PMCID: PMC7555748 DOI: 10.3390/diagnostics10090700] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/30/2020] [Revised: 09/14/2020] [Accepted: 09/15/2020] [Indexed: 12/13/2022] Open
Abstract
This study evaluates quantitative combined single photon emission tomography/computed x-ray tomography (SPECT/CT) to assess the influence of radiotracer concentration on detection of sentinel lymph nodes (SLN) in endometrial cancer (EC). Eighty EC patients underwent pericervical 99m-Tc-nanocolloid injection followed by SPECT/CT. The subgroup of patients with failed SLN detection in SPECT/CT (n = 20) was compared to match-paired patients showing at least two SLNs. Results of intraoperative gamma probe measurements and quantitative SPECT/CT were used for comparison. In patients with detection failure, the percentage of injected dose, absolute activity, and volume of the injection site were significantly lower (30 ± 24% vs. 55 ± 19%; p = 0.01, 43 ± 36 MBq vs. 73 ± 33 MBq; p = 0.04, and 183 ± 164 mL vs. 266 ± 164 mL; p = 0.03) while mean activity concentration in liver, spleen, and bone marrow was significantly higher (p = 0.02). Activity concentration (>33 KBq/mL) and absolute activity (>73 MBq) of injection areas correlated with successful intraoperative SLN detection. In a subgroup of 19 SLNs, a correlation between SPECT/CT-derived uptake and intraoperative count rate was found (R2 = 0.8; p < 0.001). SLN detection in EC patients depended on high radiotracer activity at the cervical injection site. Quantitative SPECT/CT could predict successful intraoperative SLN detection and may help to optimize injection technique.
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Affiliation(s)
- Samine Sahbai
- Department of Nuclear Medicine and Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.S.); (F.F.); (J.K.); (C.L.F.)
| | - Francesco Fiz
- Department of Nuclear Medicine and Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.S.); (F.F.); (J.K.); (C.L.F.)
| | - Florin Taran
- Gynecology and Obstetrics, University Hospital Tuebingen, 72076 Tuebingen, Germany; (F.T.); (S.B.); (D.W.)
| | - Sara Brucker
- Gynecology and Obstetrics, University Hospital Tuebingen, 72076 Tuebingen, Germany; (F.T.); (S.B.); (D.W.)
| | - Diethelm Wallwiener
- Gynecology and Obstetrics, University Hospital Tuebingen, 72076 Tuebingen, Germany; (F.T.); (S.B.); (D.W.)
| | - Juergen Kupferschlaeger
- Department of Nuclear Medicine and Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.S.); (F.F.); (J.K.); (C.L.F.)
| | - Christian La Fougère
- Department of Nuclear Medicine and Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.S.); (F.F.); (J.K.); (C.L.F.)
- Cluster of Excellence iFIT (EXC 2180) “Image Guided and Functionally Instructed Tumor Therapies”, University of Tuebingen, 72076 Tübingen, Germany
- German Cancer Consortium (DKTK), Partner Site Tuebingen, 72076 Tuebingen, Germany
| | - Helmut Dittmann
- Department of Nuclear Medicine and Molecular Imaging, University Hospital Tuebingen, 72076 Tuebingen, Germany; (S.S.); (F.F.); (J.K.); (C.L.F.)
- Correspondence: ; Tel.: +49-07071-29-86-553
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Mori T, Fukuoka M, Kazita K, Mima T, Mori K. Intraventricular Hemorrhage after Carotid Stenting. J Endovasc Ther 2016; 6:337-41. [PMID: 10893135 DOI: 10.1177/152660289900600407] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Purpose: To report an important complication related to carotid stenting. Methods and Results: A 71-year-old man with symptomatic subtotal occlusion of the left internal carotid artery had a 30-mm lesion treated percutaneously with implantation of 2 stents. Although the procedure was completed satisfactorily, left intraventricular hemorrhage occurred 4 hours later, possibly related to hyperperfusion injury. The patient expired 30 days after the stent procedure. Preoperative single-photon emission computed tomography revealed severely reduced vasoreactivity in the affected territory after acetazolamide challenge. Conclusions: The risk of hyperperfusion injury must be considered and minimized in patients with significant restriction of regional vasoreactivity. We recommend that cerebral hemodynamic status be determined prior to carotid stenting.
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Affiliation(s)
- T Mori
- Department of Neurosurgery, Kochi Medical School Hospital, Okoutyo, Nankoku City, Japan.
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Cao W, Cheng X, Li H, Wang L, Zhang X, Dong Q. Evaluation of cerebrovascular reserve using xenon-enhanced CT scanning in patients with symptomatic middle cerebral artery stenosis. J Clin Neurosci 2013; 21:293-7. [PMID: 24238634 DOI: 10.1016/j.jocn.2013.04.038] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2013] [Revised: 04/18/2013] [Accepted: 04/19/2013] [Indexed: 11/25/2022]
Abstract
Cerebrovascular reserve (CVR) is an important prognostic factor in patients with major cerebral arterial steno-occlusive disease. However, few studies have examined CVR in symptomatic intracranial stenosis without ipsilateral extracranial internal carotid artery stenosis. This study sought to evaluate CVR in patients with symptomatic middle cerebral artery (MCA) stenosis using xenon-enhanced computed tomography (Xe/CT) with acetazolamide (ACZ) challenge. Twelve patients with symptomatic MCA stenosis were recruited. All patients were examined by Xe/CT to quantitatively measure resting cerebral blood flow (CBF) and received ACZ challenge to evaluate CVR. For resting CBF, no significant differences were found between the sides in four regions of interest. After the ACZ challenge test, the CVR was significantly different between hemispheres (ipsilateral versus contralateral CVR: 12.9 ± 24.3% versus 28.0 ± 16.8%, respectively; p=0.005) and in the MCA territory (ipsilateral versus contralateral CVR: 8.7 ± 24.7% versus 29.3 ± 24%, respectively; p=0.003). However, no significant differences in CVR were detected between cortical comparisons and white matter comparisons from the two sides. Thus, ACZ-challenge Xe/CT is useful for the measurement of CBF and CVR in these patients. Impaired CVR is an important characteristic of patients with symptomatic MCA stenosis.
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Affiliation(s)
- Wenjie Cao
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Xin Cheng
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Haoxiong Li
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Liang Wang
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China
| | - Xiaolong Zhang
- Department of Radiology, Huashan Hospital, Fudan University, Shanghai, China
| | - Qiang Dong
- Department of Neurology and Institute of Neurology, Huashan Hospital, Fudan University, 12 Wulumuqi Zhong Road, Shanghai 200040, China; State Key Laboratory of Medical Neurobiology, Fudan University, Shanghai, China.
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Carlson AP, Yonas H. Radiographic assessment of vasospasm after aneurysmal subarachnoid hemorrhage: the physiological perspective. Neurol Res 2013; 31:593-604. [DOI: 10.1179/174313209x455754] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
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Choi H, Yoo MY, Cheon GJ, Kang KW, Chung JK, Lee DS. Parametric Cerebrovascular Reserve Images Using Acetazolamide (99m)Tc-HMPAO SPECT: A Feasibility Study of Quantitative Assessment. Nucl Med Mol Imaging 2013; 47:188-95. [PMID: 24900106 DOI: 10.1007/s13139-013-0214-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2013] [Revised: 06/17/2013] [Accepted: 06/19/2013] [Indexed: 11/30/2022] Open
Abstract
PURPOSE Basal/acetazolamide stress (99m)Tc-HMPAO single-photon emission computed tomography (SPECT) has been widely used for evaluation of hemodynamics; however, qualitative and subjective visual assessment of cerebrovascular reserve (CVR) has been performed in clinical settings. The aim of this study was to generate parametric CVR images and evaluate its feasibility of quantification. METHODS Basal/acetazolamide stress (99m)Tc-HMPAO SPECT data from 17 patients who underwent bypass surgery or percutaneous transluminal angioplasty were used. Spatial normalization was performed and parametric CVR images were generated using relative CVR (rCVR) of each voxel proportional to CVR of the whole brain. Binary parametric maps to show area of relatively reduced CVR were generated also using threshold of rCVR < 90 %. We calculated rCVR of internal carotid artery (ICA) using the parametric CVR images and probabilistic maps for ICA territory. Pre- and postprocedural parametric CVR images were obtained and quantitative rCVRs were compared. The rCVRs were evaluated according to visual grades for regional decreased CVR. RESULTS Postprocedural rCVR obtained from parametric CVR images increased significantly from preprocedural rCVR. The rCVR was significantly correlated with visual grades of reduced CVR for each side of ICA territories. CONCLUSIONS We generated parametric CVR images for basal/acetazolamide stress (99m)Tc-HMPAO SPECT. As a quantitative measurement, rCVR obtained from the parametric image was feasibly assessed hemodynamic abnormalities with preserved anatomical information.
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Affiliation(s)
- Hongyoon Choi
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Min Young Yoo
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Gi Jeong Cheon
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea ; Department of Nuclear Medicine, Seoul National University College of Medicine, 101 Daehangro, Jongro-gu, Seoul, 110-744 Korea
| | - Keon Wook Kang
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - June-Key Chung
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
| | - Dong Soo Lee
- Department of Nuclear Medicine, Seoul National University Hospital, Seoul, Korea
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Advanced imaging modalities in the detection of cerebral vasospasm. Neurol Res Int 2013; 2013:415960. [PMID: 23476766 PMCID: PMC3580927 DOI: 10.1155/2013/415960] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2012] [Accepted: 12/09/2012] [Indexed: 11/24/2022] Open
Abstract
The pathophysiology of cerebral vasospasm following aneurysmal subarachnoid hemorrhage (SAH) is complex and is not entirely understood. Mechanistic insights have been gained through advances in the capabilities of diagnostic imaging. Core techniques have focused on the assessment of vessel caliber, tissue metabolism, and/or regional perfusion parameters. Advances in imaging have provided clinicians with a multifaceted approach to assist in the detection of cerebral vasospasm and the diagnosis of delayed ischemic neurologic deficits (DIND). However, a single test or algorithm with broad efficacy remains elusive. This paper examines both anatomical and physiological imaging modalities applicable to post-SAH vasospasm and offers a historical background. We consider cerebral blood flow velocities measured by Transcranial Doppler Ultrasonography (TCD). Structural imaging techniques, including catheter-based Digital Subtraction Angiography (DSA), CT Angiography (CTA), and MR Angiography (MRA), are reviewed. We examine physiologic assessment by PET, HMPAO SPECT, 133Xe Clearance, Xenon-Enhanced CT (Xe/CT), Perfusion CT (PCT), and Diffusion-Weighted/MR Perfusion Imaging. Comparative advantages and limitations are discussed.
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Schubert GA, Seiz M, Czabanka M, Thomé C. Perfusion Characteristics in Chronic Cerebrovascular Insufficiency : An Anatomically and Clinically Oriented XeCT Analysis of Cerebrovascular Atherosclerotic Disease. Transl Stroke Res 2011; 3:122-9. [PMID: 24323758 DOI: 10.1007/s12975-011-0107-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2011] [Revised: 09/21/2011] [Accepted: 09/21/2011] [Indexed: 10/17/2022]
Abstract
Xenon-enhanced computed tomography (XeCT) allows quantification of hemodynamic insufficiency in the setting of cerebrovascular atherosclerotic disease (CAD). However, data regarding the relationship between hemodynamic indices [cerebral blood flow (CBF) and cerebrovascular reserve capacity (CVRC)] and normal subjects (with aging) and pathology (progression of CAD or development of stroke symptoms) are limited. In this study, we analyzed 103 consecutive patients undergoing XeCT according to age, anatomical location and disease severity. We stratified anatomically defined ROIs according to a classification system that observes the presence of proximal stenosis (class I vs. class II/III) as well as the presence of neurological symptoms (class II vs. III); CBF, CVRC and hemodynamic stress distribution were calculated. Supratentorial CBF decreases significantly with age, but not infratentorially. Cortical CVRC remains stable over time. Our classification of disease severity correlated highly significantly with a decrease in supratentorial CBF and CVRC, though CVRC is less sensitive to age-related changes. Regression analysis delineated a CVRC of 34% to discriminate between ROI classes. Age-dependent perfusion characteristics in normal vascular territories were characterized. In CAD, CVRC remains the most sensitive parameter. A simplified classification of ROIs according to disease severity correlates well with established markers for hemodynamic insufficiency. It may facilitate comparison of different pathologies such as CAD and Moyamoya disease and will be the focus of further studies.
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10
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Interventional Neuroradiologic Therapy of Atherosclerotic Disease and Vascular Malformations. Stroke 2011. [DOI: 10.1016/b978-1-4160-5478-8.10061-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
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Calviere L, Catalaa I, Marlats F, Viguier A, Bonneville F, Cognard C, Larrue V. Correlation between cognitive impairment and cerebral hemodynamic disturbances on perfusion magnetic resonance imaging in European adults with moyamoya disease. J Neurosurg 2010; 113:753-9. [DOI: 10.3171/2010.4.jns091808] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Object
Although cognitive impairment has been reported in adults with moyamoya disease (MMD), its relationship with cerebral hemodynamic disturbances has not been investigated. The aims of the present study were to confirm the presence of dysexecutive cognitive syndrome (DCS) in adults with MMD and to explore the relationship of DCS with frontal lobe perfusion as measured by perfusion MR imaging.
Methods
Cerebral blood volume (CBV) ratio and mean transit time delay were measured in frontal and temporoparietal regions using the cerebellum as a reference region in 10 European adults with MMD. In addition, the authors calculated the cerebrovascular reserve (CVR) using the CBV ratio and the acetazolamide challenge. All patients underwent a standardized neuropsychological assessment test battery. The authors defined DCS as an impairment shown on 3 tests or more of executive function.
Results
The authors found DCS in 6 patients. The frontal CVR was lower in patients with DCS than in patients without DCS (mean ± SD: −13.5 ± 13.2% and 20.3 ± 21.3%; p = 0.019, Mann-Whitney U-test). Other parameters of frontal perfusion and temporoparietal CVR were not correlated with DCS.
Conclusions
The authors' findings suggest that DCS is common in European adults with MMD and may be related to frontal perfusion impairment.
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Affiliation(s)
| | - Isabelle Catalaa
- 2Neuroradiology, University of Toulouse, Rangueil Hospital, Toulouse, France
| | | | | | - Fabrice Bonneville
- 2Neuroradiology, University of Toulouse, Rangueil Hospital, Toulouse, France
| | - Christophe Cognard
- 2Neuroradiology, University of Toulouse, Rangueil Hospital, Toulouse, France
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Langner S, Fleck S, Seipel R, Schroeder HWS, Hosten N, Kirsch M. Perfusion CT scanning and CT angiography in the evaluation of extracranial-intracranial bypass grafts. J Neurosurg 2010; 114:978-83. [PMID: 20617876 DOI: 10.3171/2010.6.jns10117] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Extracranial-intracranial (EC-IC) bypass surgery remains an important treatment alternative for patients with occlusive cerebrovascular disease. The aim of the present study was to use perfusion CT and CT angiography (CTA) to evaluate cerebral hemodynamics and bypass patency in patients with occlusive cerebrovascular disease before and after EC-IC bypass surgery. METHODS Ten patients underwent perfusion CT and CTA before and after bypass surgery. Preoperative and postoperative digital subtraction angiography served as the diagnostic gold standard. An artery bypass was established from the superficial temporal artery to a cortical branch of the middle cerebral artery. Perfusion CT scanning was performed at the level of the basal ganglia. Color-coded perfusion maps of cerebral blood volume, cerebral blood flow, and time to peak were calculated. RESULTS Preoperative perfusion CT showed significant prolonged time to peak and reduced cerebral blood flow of the affected hemisphere. Postoperative neurological deterioration did not develop in any patient. Computed tomography angiography provided adequate evaluation of the anastomoses as well as the course and caliber of the bypass and confirmed bypass patency in all patients. Postoperative perfusion CT showed improved cerebral hemodynamics with a return to nearly normal perfusion parameters. CONCLUSIONS Computed tomography angiography is a noninvasive and reliable tool for evaluating patients with EC-IC bypass. Perfusion CT allows monitoring of hemodynamic changes after bypass surgery. The combination of both modalities enables noninvasive anatomical and functional analysis of superficial temporal artery-middle cerebral artery anastomoses using a single CT protocol. Hemodynamic evaluation of patients with occlusive cerebrovascular disease before and after surgery may improve the prediction of outcome and may help identify patients in whom a bypass procedure can be performed.
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Affiliation(s)
- Soenke Langner
- Institute for Diagnostic Radiology and Neuroradiology, Ernst-Moritz-Arndt-University Greifswald, Germany.
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Zaharchuk G, Bammer R, Straka M, Newbould RD, Rosenberg J, Olivot JM, Mlynash M, Lansberg MG, Schwartz NE, Marks MM, Albers GW, Moseley ME. Improving dynamic susceptibility contrast MRI measurement of quantitative cerebral blood flow using corrections for partial volume and nonlinear contrast relaxivity: A xenon computed tomographic comparative study. J Magn Reson Imaging 2009; 30:743-52. [PMID: 19787719 DOI: 10.1002/jmri.21908] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To test whether dynamic susceptibility contrast MRI-based CBF measurements are improved with arterial input function (AIF) partial volume (PV) and nonlinear contrast relaxivity correction, using a gold-standard CBF method, xenon computed tomography (xeCT). MATERIALS AND METHODS Eighteen patients with cerebrovascular disease underwent xeCT and MRI within 36 h. PV was measured as the ratio of the area under the AIF and the venous output function (VOF) concentration curves. A correction was applied to account for the nonlinear relaxivity of bulk blood (BB). Mean CBF was measured with both techniques and regression analyses both within and between patients were performed. RESULTS Mean xeCT CBF was 43.3 +/- 13.7 mL/100g/min (mean +/- SD). BB correction decreased CBF by a factor of 4.7 +/- 0.4, but did not affect precision. The least-biased CBF measurement was with BB but without PV correction (45.8 +/- 17.2 mL/100 g/min, coefficient of variation [COV] = 32%). Precision improved with PV correction, although absolute CBF was mildly underestimated (34.3 +/- 10.8 mL/100 g/min, COV = 27%). Between patients correlation was moderate even with both corrections (R = 0.53). CONCLUSION Corrections for AIF PV and nonlinear BB relaxivity improve bolus MRI-based CBF maps. However, there remain challenges given the moderate between-patient correlation, which limit diagnostic confidence of such measurements in individual patients.
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Affiliation(s)
- Greg Zaharchuk
- Department of Radiology, Stanford University, Stanford, California, USA.
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Zaharchuk G, Bammer R, Straka M, Shankaranarayan A, Alsop DC, Fischbein NJ, Atlas SW, Moseley ME. Arterial spin-label imaging in patients with normal bolus perfusion-weighted MR imaging findings: pilot identification of the borderzone sign. Radiology 2009; 252:797-807. [PMID: 19703858 DOI: 10.1148/radiol.2523082018] [Citation(s) in RCA: 71] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
PURPOSE To determine whether perfusion abnormalities are depicted on arterial spin-labeling (ASL) images obtained in patients with normal bolus perfusion-weighted (PW) magnetic resonance (MR) imaging findings. MATERIALS AND METHODS Institutional review board approval and written informed patient consent were obtained. This study was HIPAA compliant. Consecutive patients suspected or known to have cerebrovascular disease underwent 1.5-T brain MR imaging, including MR angiography, gradient-echo PW imaging, and pseudocontinuous ASL imaging, between October 2007 and January 2008. Patients with normal bolus PW imaging findings were retrospectively identified, and two neuroradiologists subsequently evaluated the ASL images for focal abnormalities. The severity of the borderzone sign-that is, bilateral ASL signal dropout with surrounding cortical areas of hyperintensity in the middle cerebral artery borderzone regions-was classified by using a four-point scale. For each group, the ASL-measured mean mixed cortical cerebral blood flow (CBF) at the level of the centrum semiovale was evaluated by using the Jonckheere-Terpstra test. RESULTS One hundred thirty-nine patients met the study inclusion criteria, and 41 (30%) of them had normal bolus PW imaging findings. Twenty-three (56%) of these 41 patients also had normal ASL imaging findings. The remaining 18 (44%) patients had the ASL borderzone sign; these patients were older (mean age, 71 years +/- 11 [standard deviation] vs 57 years +/- 16; P < .005) and had lower mean CBF (30 mL/100 g/min +/- 12 vs 46 mL/100 g/min +/- 12, P < .003) compared with the patients who had normal ASL imaging findings. Five patients had additional focal ASL findings that were related to either slow blood flow in a vascular structure or postsurgical perfusion defects and were not visible on the PW images. CONCLUSION Approximately half of the patients with normal bolus PW imaging findings had abnormal ASL findings-most commonly the borderzone sign. Results of this pilot study suggest that ASL imaging in patients who have this sign and are suspected of having cerebrovascular disease yields additional and complementary hemodynamic information.
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Affiliation(s)
- Greg Zaharchuk
- Department of Radiology, Stanford University Medical Center, 1201 Welch Rd, PS-04, MC 5488, Stanford, CA 94305-5488, USA.
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Okazawa H, Kudo T. Clinical impact of hemodynamic parameter measurement for cerebrovascular disease using positron emission tomography and 15O-labeled tracers. Ann Nucl Med 2009; 23:217-27. [PMID: 19353235 DOI: 10.1007/s12149-009-0235-7] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/13/2008] [Accepted: 11/17/2008] [Indexed: 10/20/2022]
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Vagal AS, Leach JL, Fernandez-Ulloa M, Zuccarello M. The acetazolamide challenge: techniques and applications in the evaluation of chronic cerebral ischemia. AJNR Am J Neuroradiol 2009; 30:876-84. [PMID: 19246526 DOI: 10.3174/ajnr.a1538] [Citation(s) in RCA: 113] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
The acetazolamide (ACZ) challenge test is a useful clinical tool and a reliable predictor of critically reduced perfusion. In patients with chronic steno-occlusive disease, the ability to maintain normal cerebral blood flow by reducing vascular resistance secondary to autoregulatory vasodilation is compromised. Identification of the presence and degree of autoregulatory vasodilation (reflecting the cerebrovascular reserve) is a significant prognostic factor in patients with chronic cerebrovascular disease. The pharmacologic challenge of a vasodilatory stimulus such as ACZ can also be used to optimize the treatment strategies for these patients. The pathophysiology, methods, and clinical applications of the ACZ challenge test are discussed in this article.
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Affiliation(s)
- A S Vagal
- Department of Radiology, Section of Neuroradiology, University of Cincinnati College of Medicine, Cincinnati, Ohio 45267-0762, USA.
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STA–MCA bypass for symptomatic carotid occlusion and haemodynamic impairment. J Clin Neurosci 2009; 16:226-35. [DOI: 10.1016/j.jocn.2008.01.022] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2007] [Accepted: 01/27/2008] [Indexed: 11/22/2022]
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Zaharchuk G, Martin AJ, Dillon WP. Noninvasive imaging of quantitative cerebral blood flow changes during 100% oxygen inhalation using arterial spin-labeling MR imaging. AJNR Am J Neuroradiol 2008; 29:663-7. [PMID: 18397966 DOI: 10.3174/ajnr.a0896] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022]
Abstract
BACKGROUND AND PURPOSE Tracer studies have demonstrated that 100% oxygen inhalation causes a small cerebral blood flow (CBF) decrease. This study was performed to determine whether arterial spin-labeling (ASL), a noninvasive MR imaging technique, could image these changes with clinically reasonable imaging durations. MATERIALS AND METHODS Continuous ASL imaging was performed in 7 healthy subjects before, during, and after 100% oxygen inhalation. ASL difference signal intensity (DeltaM, control - label), CBF, and CBF percentage change were measured. A test-retest paradigm was used to calculate the variability of the initial and final room air CBF measurements. RESULTS During oxygen inhalation, DeltaM decreased significantly in all regions (eg, global DeltaM decreased by 23 +/- 11%, P < .01, all values mean +/- SD). Accounting for the reduced T1 of hyperoxygenated blood, we found a smaller CBF decrease, which did not reach significance in any of the regions. Global CBF dropped from 50 +/- 10 mL per 100 g/minute to 47 +/- 10 mL per 100 g/minute following 100% oxygen inhalation, a decrease of 5 +/- 14% (P > .17). The root-mean-square variability of the initial and final room air CBF measurements was 7-8 mL per 100 g/minute. CONCLUSIONS The DeltaM signal intensity decreased significantly with oxygen inhalation; however, after accounting for changes in blood T1 with oxygen, CBF decreases were small. Such measurements support the use of hyperoxia as an MR imaging contrast agent and may be helpful to interpret hyperoxia-based stroke trials.
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Affiliation(s)
- G Zaharchuk
- Department of Radiology, Stanford University, Stanford, CA 94305-5487, USA.
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19
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Wintermark M, Sincic R, Sridhar D, Chien JD. Cerebral perfusion CT: technique and clinical applications. J Neuroradiol 2008; 35:253-60. [PMID: 18466974 DOI: 10.1016/j.neurad.2008.03.005] [Citation(s) in RCA: 64] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2008] [Accepted: 03/05/2008] [Indexed: 12/29/2022]
Abstract
Perfusion computed tomography (PCT) is an imaging technique that allows rapid, noninvasive, quantitative evaluation of cerebral perfusion by generating maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). The concepts behind this imaging technique were developed in the 1980s', but its widespread clinical use was allowed by the recent introduction of rapid, large-coverage multidetector-row CT scanners. Key clinical applications for PCT include the diagnosis of cerebral ischemia and infarction, and evaluation of vasospasm after subarachnoid hemorrhage. PCT measurements of cerebrovascular reserve after acetazolamide challenges in patients with vascular stenoses permit evaluation of candidacy for bypass surgery and endovascular treatment. PCT has also been used to assess cerebral perfusion after head trauma and microvascular permeability in the setting of intracranial neoplasm. Some controversy exists regarding this technique, including questions regarding correct selection of an arterial input vessel, the accuracy of quantitative results, and the reproducibility of results. This article provides an overview of PCT, including details of technique, major clinical applications, and limitations.
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Affiliation(s)
- M Wintermark
- Department of Radiology, Neuroradiology Section, University of California, 505, Parnassus Avenue, Box 0628, San Francisco, CA 94143-0628, USA.
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20
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Chibbaro S, Tacconi L. Extracranial-intracranial bypass for the treatment of cavernous sinus aneurysms. J Clin Neurosci 2006; 13:1001-5. [PMID: 17070053 DOI: 10.1016/j.jocn.2005.07.027] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2005] [Accepted: 07/19/2005] [Indexed: 11/21/2022]
Abstract
The optimal management of symptomatic cavernous sinus aneurysms remains controversial. Carotid occlusion is a simple procedure, but carries an ongoing risk of early and late stroke. Cerebral revascularisation is technically demanding and carries a risk of morbidity and mortality of around 10%. Eight patients treated with an extracranial-intracranial vascular bypass graft over a period of 44 months for symptomatic cavernous sinus aneurysms are reviewed. At a mean follow-up of 20 months, seven patients (87.5%) had an excellent outcome (Glasgow Outcome Score 5) while one patient suffered a perioperative stroke. In only one case, where the radial artery had been used, the graft became occluded. The results of this series seem to indicate that cerebral revascularisation is an effective treatment for patients with symptomatic cavernous sinus aneurysms.
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MESH Headings
- Adult
- Aged
- Carotid Artery, External/anatomy & histology
- Carotid Artery, External/surgery
- Carotid Artery, Internal/diagnostic imaging
- Carotid Artery, Internal/pathology
- Carotid Artery, Internal/surgery
- Carotid Artery, Internal, Dissection/pathology
- Carotid Artery, Internal, Dissection/physiopathology
- Carotid Artery, Internal, Dissection/surgery
- Cavernous Sinus/diagnostic imaging
- Cavernous Sinus/pathology
- Cavernous Sinus/surgery
- Cerebral Angiography
- Cerebral Revascularization/methods
- Cerebral Revascularization/trends
- Female
- Humans
- Intracranial Aneurysm/diagnostic imaging
- Intracranial Aneurysm/pathology
- Intracranial Aneurysm/surgery
- Intraoperative Complications/etiology
- Intraoperative Complications/physiopathology
- Intraoperative Complications/prevention & control
- Male
- Middle Aged
- Ophthalmoplegia/etiology
- Ophthalmoplegia/physiopathology
- Ophthalmoplegia/surgery
- Postoperative Care/standards
- Postoperative Complications/etiology
- Postoperative Complications/physiopathology
- Postoperative Complications/prevention & control
- Radial Artery/anatomy & histology
- Radial Artery/surgery
- Retrospective Studies
- Risk Assessment
- Saphenous Vein/anatomy & histology
- Saphenous Vein/surgery
- Stroke/etiology
- Stroke/physiopathology
- Stroke/prevention & control
- Tissue Transplantation/methods
- Tissue Transplantation/trends
- Treatment Outcome
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Affiliation(s)
- S Chibbaro
- Department of Neurosurgery, University Hospital Trieste, Strada di Fiume 447, 34100 Trieste, Italy
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21
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Yonas H, Sesay M, Calli C, Liu HM, Lomena F, Nasel C, Meyer JS, Yunten N, Anckarsater H, Wintermark M. The goal is quantitative cerebral blood flow. J Neuroradiol 2005; 32:291-3. [PMID: 16424828 DOI: 10.1016/s0150-9861(05)83158-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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22
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Abstract
Cerebrovascular reserve reflects the capacity of the brain to maintain adequate blood flow in the face of decreased perfusion pressure. Perfusion imaging, combined with a physiologic or pharmacologic challenge, is a direct method of measuring cerebrovascular reserve. The authors discuss the strengths and drawbacks of each of the methods of cerebrovascular reserve assessment. They review the applications of cerebrovascular reserve testing, particularly in the assessment of stroke risk in the setting of chronic stenosis or occlusion of vessels in the head and neck.
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Affiliation(s)
- Clifford J Eskey
- Division of Neuroradiology, Dartmouth Hitchcock Medical Center, Lebanon, NH 03756, USA.
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23
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Abstract
Herein, the author discusses four perfusion technologies, including the diffusible tracer methods-xenon-enhanced computed tomography (CT) and single photon emission CT with various radioisotopes-and the nondiffusible tracer techniques-CT perfusion and magnetic resonance (MR) perfusion and diffusion. The methods for and important issues in the performance of each technique are presented, along with the accuracy of the data acquired with each technique, as demonstrated with experimental studies. In addition, the use of each technique in the evaluation of patients with acute stroke and their relative advantages and disadvantages are presented.
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Affiliation(s)
- Richard E Latchaw
- Department of Radiology, University of California at Davis, Sacramento, California 95616, USA.
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24
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Nemoto EM, Yonas H, Kuwabara H, Pindzola RR, Sashin D, Meltzer CC, Price JC, Chang Y, Johnson DW. Identification of hemodynamic compromise by cerebrovascular reserve and oxygen extraction fraction in occlusive vascular disease. J Cereb Blood Flow Metab 2004; 24:1081-9. [PMID: 15529008 DOI: 10.1097/01.wcb.0000125887.48838.37] [Citation(s) in RCA: 56] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/09/2023]
Abstract
Cerebrovascular reserve (CVR) and oxygen extraction fraction (OEF) are used to identify hemodynamic compromise in symptomatic patients with carotid occlusive vascular disease, but evidence suggests that they are not equivalent. The authors studied the relationship between CVR and OEF to evaluate their equivalence and stages of hemodynamic compromise. Symptomatic patients (N = 12) with carotid occlusion were studied by stable xenon-computed tomography CBF after intravenous acetazolamide administration for CVR, followed within 24 hours by positron emission tomography (PET) for OEF. Middle cerebral artery territories were analyzed by hemisphere and level. Hemispheric subcortical white matter infarctions were graded with magnetic resonance imaging. Both hemispheric and level analysis of CVR and OEF showed a significant (P = 0.001), negative linear relationship [CVR (%) = -1.5 (OEF) + 83.4, (r = -0.57, P = 0.001, n = 24]. However, 37.5% of the hemispheres showed compromised CVR but normal OEF and were associated (P = 0.019) with subcortical white matter infarction. CMRO2 was elevated in stage II hemodynamic compromise (CVR < 10%, OEF > 50%). CVR and OEF showed a significant negative linear relationship in stage II hemodynamic compromise but revealed hemispheres in hemodynamic compromise by CVR but normal OEF that were associated with subcortical white matter infarction.
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Affiliation(s)
- Edwin M Nemoto
- Department of Neurological Surgery, University of Pittsburgh Medical Center, Pennsylvania, USA.
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25
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Abstract
In order to evaluate the clinical utility of non-enhanced CT with perfusion and angio CT in the assessment of acute ischaemic stroke, 42 patients with symptoms of acute stroke were examined within the first 6 h from onset of symptoms with non-enhanced CT (NECT), perfusion CT (PCT) and CT angiography (CTA). Maps of cerebral blood flow (CBF), cerebral blood volume (CBV) and mean transit time (MTT) were analysed visually, and after drawing regions of interest (ROIs) in the territory of anterior, middle and posterior cerebral arteries, maximum-intensity projection and volume-rendering images of the cervical and cerebral vessels were created. All patients underwent a control CT or MR examination 24-48 h after the initial examination. Twenty-nine patients developed an area of infarction at control examinations. Significant perfusion abnormalities were found in 27 cases, whilst in two patients the perfusion studies were considered to be normal. All the cases with perfusion abnormalities showed arterial stenoses or occlusions on angio CT. Small infarctions at levels other than the ones selected for perfusion CT, and arteriosclerotic changes, were observed in the two cases with no perfusion abnormalities. In conclusion, combining non-enhanced CT with PCT and CTA is a simple and a very valuable tool in the initial assessment of acute stroke.
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Affiliation(s)
- J M Esteban
- Department of CT and MR, ERESA, Hospital General Universitario, Valencia, Spain.
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26
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Nogami K, Fujii M, Kato S, Nishizaki T, Suzuki M, Yamashita S, Oda Y, Sadamitsu D, Maekawa T. Analysis of magnetic resonance imaging (MRI) morphometry and cerebral blood flow in patients with hypoxic-ischemic encephalopathy. J Clin Neurosci 2004; 11:376-80. [PMID: 15080951 DOI: 10.1016/j.jocn.2002.12.006] [Citation(s) in RCA: 18] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/28/2002] [Accepted: 12/05/2002] [Indexed: 10/26/2022]
Abstract
The aim of this study was to analyze magnetic resonance imaging (MRI) morphometry and cerebral blood flow (CBF) in patients with hypoxic-ischemic encephalopathy, and determine the viability of such measurements for predicting cerebral outcome. The subjects were 26 patients with histories of cardiopulmonary resuscitation who had subsequently developed encephalopathy. We examined the CBF using stable xenon-computed tomography (Xe-CT) and MR images in the subacute period (8-20 days). Three signal-change patterns in the basal ganglia emerged in the MRI study. The first pattern, isointense areas evident in both the T1-weighted image (T1WI) and the T2-weighted image (T2WI), was observed in four patients with favorable outcomes. The second pattern, iso- or hypointense areas evident in the T1WI and hyperintense areas evident in the T2WI, was observed in six patients with favorable outcomes and three patients with poor outcomes. The third pattern, hyperintense areas evident in both the T1WI and T2WI, was observed in 13 patients with poor outcomes. Hemispheric CBFs were 38.9+/-4.6 (mean (SD)) ml/100 g/min in patients with favorable outcomes and 25.3+/-4.3 ml/100 g/min in patients with poor outcomes (p < 0.01). The CBF increase after acetazolamide administration was 13.3+/-3.4 ml/100 g/min in patients with favorable outcomes and 6.8+/-5.6 ml/100 g/min in patients with poor outcomes ( p < 0.05). The presence of hyperintense lesions in the basal ganglia in T1WI, low hemispheric CBF ( < 30 ml/100 g/min), and low acetazolamide reactivity ( < 10 ml/100 g/min) are all factors associated with poor outcome in patients with hypoxic-ischemic encephalopathy.
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Affiliation(s)
- Kenichiro Nogami
- Department of Neurosurgery, University of Yamaguchi School of Medicine, Ube, Yamaguchi, Japan
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27
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Hoeffner EG, Case I, Jain R, Gujar SK, Shah GV, Deveikis JP, Carlos RC, Thompson BG, Harrigan MR, Mukherji SK. Cerebral perfusion CT: technique and clinical applications. Radiology 2004; 231:632-44. [PMID: 15118110 DOI: 10.1148/radiol.2313021488] [Citation(s) in RCA: 261] [Impact Index Per Article: 13.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
Perfusion computed tomography (CT) is a relatively new technique that allows rapid qualitative and quantitative evaluation of cerebral perfusion by generating maps of cerebral blood flow (CBF), cerebral blood volume (CBV), and mean transit time (MTT). The technique is based on the central volume principle (CBF = CBV/MTT) and requires the use of commercially available software employing complex deconvolution algorithms to produce the perfusion maps. Some controversies exist regarding this technique, including which artery to use as input vessel, the accuracy of quantitative results, and the reproducibility of results. Despite these controversies, perfusion CT has been found to be useful for noninvasive diagnosis of cerebral ischemia and infarction and for evaluation of vasospasm after subarachnoid hemorrhage. Perfusion CT has also been used for assessment of cerebrovascular reserve by using acetazolamide challenge in patients with intracranial vascular stenoses who are potential candidates for bypass surgery or neuroendovascular treatment, for the evaluation of patients undergoing temporary balloon occlusion to assess collateral flow and cerebrovascular reserve, and for the assessment of microvascular permeability in patients with intracranial neoplasms. This article is a review of the technique, clinical applications, and controversies surrounding perfusion CT.
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Affiliation(s)
- Ellen G Hoeffner
- Departments of Radiology and Neurosurgery, University of Michigan Health System, 1500 E Medical Center Drive, University Hospital B2 A209, Ann Arbor, MI 48109, USA.
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28
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Boles Ponto LL, Schultz SK, Leonard Watkins G, Hichwa RD. Technical issues in the determination of cerebrovascular reserve in elderly subjects using 15O-water PET imaging. Neuroimage 2004; 21:201-10. [PMID: 14741657 DOI: 10.1016/j.neuroimage.2003.09.044] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/26/2022] Open
Abstract
The accurate determination of cerebrovascular reserve (CVR), especially in elderly subjects, entails several technical issues. From a review of the literature, the optimal technique employs quantitative 15O-water PET imaging determinations of cerebral blood flow (CBF) and acetazolamide (ACZ) (1 g iv with measurements at 10- to 20-min post-administration) as the vasodilating agent. CBF and CVR measurements were made using this methodology on 12 elderly subjects (3 males, 9 females, 66-84 years of age) meeting criteria for mild cognitive impairment (MCI) without other significant medical problems. Applying this quantitative technique, the cognitive and emotional status of the subject during the imaging procedure influenced the magnitude of the measurements. The semiquantitative measures resulted in even more pronounced subject state influences. The conditions under which CBF or CVR measurements are made should be controlled and reported. If semiquantitative techniques (e.g., single-photon emission-computed tomography [SPECT] imaging) must be employed for the determination of CVR, the validity of any measurement is dependent on the careful control of the general physiological status (e.g., heart rate, blood pressure, level of anxiety) of the patient.
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Affiliation(s)
- Laura L Boles Ponto
- Positron Emission Tomography Imaging Center, Department of Radiology, Roy J. and Lucille A. Carver College of Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA 52242, USA.
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29
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Levy EI, Kim SH, Bendok BR, Boulos AS, Xavier AR, Yahia AM, Qureshi AI, Guterman LR, Hopkins LN. Interventional Neuroradiologic Therapy. Stroke 2004. [DOI: 10.1016/b0-44-306600-0/50087-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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30
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Joseph M, Ziadi S, Nates J, Dannenbaum M, Malkoff M. Increases in Cardiac Output Can Reverse Flow Deficits from Vasospasm Independent of Blood Pressure: A Study Using Xenon Computed Tomographic Measurement of Cerebral Blood Flow. Neurosurgery 2003; 53:1044-51; discussion 1051-2. [PMID: 14580270 DOI: 10.1227/01.neu.0000088567.59324.78] [Citation(s) in RCA: 127] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2003] [Accepted: 07/11/2003] [Indexed: 11/19/2022] Open
Abstract
Abstract
INTRODUCTION
Vasospasm after subarachnoid hemorrhage remains a management challenge. The accepted treatment involves hypertensive, hypervolemic, hemodilution therapy. However, there is variation in the application of this treatment. Most authors increase mean arterial pressure (MAP), which can be associated with significant morbidity. Others increase cardiac output (CO). In this study, we examined the relationship between volume status, CO, and MAP and cerebral blood flow (CBF) in the setting of vasospasm.
METHODS
A xenon blood flow tomography-based system was used to quantitate CBF. Sixteen patients with vasospasm after subarachnoid hemorrhage were treated with hypervolemia, phenylephrine to increase MAP, or dobutamine to increase CO. Direct CBF measurements were obtained before and after treatment. A strength of this study is that only one variable (central venous pressure, MAP, or CO) was manipulated in each patient, and the effect of this change was measured immediately.
RESULTS
With phenylephrine, mean MAP increased from 102.4 to 132.1 mm Hg. In regions of diminished CBF due to vasospasm, mean CBF increased from 19.2 to 33.7 ml/100 g/min. Similarly, dobutamine increased the cardiac index from a mean of 4.1 to 6.0 L/min/m2 and slightly decreased MAP. CBF increased from a mean of 24.8 to 35.4 ml/100 g/min. Both were statistically significant changes. With hypervolemia, the average central venous pressure increased from a mean of 5.4 to 7.3 cm H2O; no changes in mean CBF were noted.
CONCLUSION
This article reports the first human study that shows with direct measurements the independent influence of CO in the setting of vasospasm. Increases in CO without changes in MAP can elevate CBF. This finding has immediate clinical application because CO manipulation is much safer than increasing MAP. Because both interventions were equally efficacious, our protocol has been changed to augment CO as a first measure. Induced hypertension is reserved for patients in whom this initial treatment fails.
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Affiliation(s)
- Mathew Joseph
- Department of Neurosurgery, University of Texas Health Science Center, Houston, Texas, USA.
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31
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Sagher O, Huang DL, Keep RF. Spinal cord stimulation reducing infarct volume in a model of focal cerebral ischemia in rats. J Neurosurg 2003; 99:131-7. [PMID: 12854755 DOI: 10.3171/jns.2003.99.1.0131] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT The authors previously showed that spinal cord stimulation (SCS) increases cerebral blood flow in rats, indicating that this technique may be useful in the treatment of focal cerebral ischemia. In the present study, the neuroprotective potential of SCS in the setting of middle cerebral artery occlusion (MCAO) was investigated. METHODS The authors induced permanent, focal cerebral ischemia by using either suture-induced occlusion or direct division of the MCA in Sprague-Dawley rats. Electrical stimulation of the cervical spinal cord was performed during cerebral ischemia. Cerebral blood flow was assessed using both laser Doppler flowmetry (LDF) and quantitative radiotracer analysis. Stroke volumes were analyzed after 6 hours of ischemia. Spinal cord stimulation resulted in a 52.7 +/- 13.3% increase in LDF values (nine animals). Following MCAO, LDF values decreased by 64.1 +/- 3.6% from baseline values (10 animals). Spinal cord stimulation subsequently increased LDF values to 30.9 +/- 13.5% below original baseline values. These findings were corroborated using radiotracer studies. Spinal cord stimulation in the setting of transcranial MCAO significantly reduced stroke volumes as well (from 203 +/- 33 mm3 [control] to 32 +/- 8 mm3 [MCAO plus SCS], seven animals in each group, p < 0.001). Similarly, after suture-induced MCAO, SCS reduced stroke volumes (from 307 +/- 29 mm3 [control] to 78 +/- 22 mm3 [MCAO plus SCS], 10 animals in each group, p < 0.001). CONCLUSIONS A strategy of performing SCS for the prevention of critical ischemia is feasible and may have the potential for the treatment and prevention of stroke.
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Affiliation(s)
- Oren Sagher
- Department of Neurosurgery, University of Michigan Health System, Ann Arbor, Michigan 48109-0338, USA.
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Tseng MY, Al-Rawi PG, Pickard JD, Rasulo FA, Kirkpatrick PJ. Effect of hypertonic saline on cerebral blood flow in poor-grade patients with subarachnoid hemorrhage. Stroke 2003; 34:1389-96. [PMID: 12730557 DOI: 10.1161/01.str.0000071526.45277.44] [Citation(s) in RCA: 94] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The goal of this study was to examine the effects of hypertonic saline on cerebral blood flow (CBF) in poor-grade patients with subarachnoid hemorrhage. METHODS We administered 23.5% hypertonic saline (2 mL/kg IV) 1 time to 10 patients, 2 times to 7 patients, and 3 times to 1 patient. All patients had transcranial Doppler (TCD), intracranial pressure (ICP) monitoring, and analysis of serum sodium and osmolality; 6 had xenon CT (XeCT). Data were used to characterize the changes in CBF, cerebral vascular resistance (CVR), ICP, cerebral perfusion pressure (CPP), and potential rheological mechanisms of action. RESULTS In the first treatment episode, CPP increased 26.8% (P=0.0003, at 28.3 minutes) from a rise in mean arterial blood pressure (ABP) of 10.5% (P=0.02, at 22.2 minutes) and a fall in ICP (-74.7%, P=0.002, at 60.0 minutes). Flow velocity (FV) of the middle cerebral artery increased 70.8% (P=0.00005, at 20.0 minutes), resulting in a corresponding fall in estimated CVR (-26.6%, P=0.01, at 16.3 minutes). The half-lives of effects on ABP, CPP, ICP, FV, and estimated CVR were 20.0, 53.6, 139.1, 42.7, and 27.1 minutes, respectively. In the second treatment episode, all these parameters had the same response except estimated CVR, which did not reach statistical significance. XeCT confirmed the increase in CBF (22.9%, P=0.02) without regional differences. A fall in CBF after hypertonic saline was identified in only a single region of interest in a patient in whom baseline flow was low but not infarcted. Serum sodium rose by 11.4 and 8.8 mmol/L, and osmolality rose by 26.7 and 16.3 mosm/L in the first and second treatment episodes, respectively. Hemoglobin decreased by 0.7 and 0.6 g/L and hematocrit decreased by 1.9% and 2.4% in the first and second treatment episodes, respectively. CONCLUSIONS We found that 23.5% hypertonic saline increases CBF in poor-grade patients with subarachnoid hemorrhage. These effects are associated with improved indexes of blood rheology. Potential therapeutic benefits are discussed.
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Affiliation(s)
- Ming-Yuan Tseng
- Academic Department of Neurosurgery, Addenbrooke's Hospital, Hills Road, Cambridge CB2 2QQ, UK
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33
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Hosoda K, Kawaguchi T, Ishii K, Minoshima S, Shibata Y, Iwakura M, Ishiguro S, Kohmura E. Prediction of hyperperfusion after carotid endarterectomy by brain SPECT analysis with semiquantitative statistical mapping method. Stroke 2003; 34:1187-93. [PMID: 12702841 DOI: 10.1161/01.str.0000068781.31429.be] [Citation(s) in RCA: 73] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Hyperperfusion syndrome is a rare but disastrous complication after carotid endarterectomy (CEA). The aim of this study was to investigate the relationship between preoperative cerebral blood flow (CBF) abnormalities and postoperative hyperperfusion through the use of statistical brain mapping analysis. METHODS For 41 patients with unilateral carotid stenosis >or=70%, CBF and cerebral vasoreactivity (CVR) were investigated with resting and acetazolamide-challenge single photon emission CT before CEA. CBF 1 day after CEA was also measured. Three-dimensional stereotactic surface projection (3D-SSP) analysis of CBF changes was performed by use of a control database of 20 subjects. RESULTS Patients with reduced CVR (CVR <10%, n=15) were categorized into 2 groups based on the severity of CBF reduction relative to the control database by 3D-SSP analysis without normalization: type I (ipsilateral CBF decrease <20%, n=8) and type II (ipsilateral CBF decrease >or=20%, n=7). With thalamic normalization, the patients were also categorized into 2 groups: type A (ipsilateral Z score <or=2, n=10) and type B (ipsilateral Z score >2, n=5). Severe CBF reduction (>or=20% or Z score >2) was significantly associated with postoperative hyperperfusion (CBF increase >or=100%). However, 3D-SSP with thalamic normalization (Z score) demonstrated a higher predictive value (80%) and specificity (91%) for hyperperfusion than 3D-SSP without normalization (percent reduction) (57% and 73%, respectively). No patients with normal CVR (CVR >or=10%, n=26) demonstrated postoperative hyperperfusion. CONCLUSIONS Objective evaluation of abnormalities of CBF and CVR with 3D-SSP could identify patients at risk for postoperative hyperperfusion.
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Affiliation(s)
- Kohkichi Hosoda
- Department of Neurosurgery, Hyogo Brain and Heart Center, Himeji, Japan.
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34
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Latchaw RE, Yonas H, Hunter GJ, Yuh WTC, Ueda T, Sorensen AG, Sunshine JL, Biller J, Wechsler L, Higashida R, Hademenos G. Guidelines and recommendations for perfusion imaging in cerebral ischemia: A scientific statement for healthcare professionals by the writing group on perfusion imaging, from the Council on Cardiovascular Radiology of the American Heart Association. Stroke 2003; 34:1084-104. [PMID: 12677088 DOI: 10.1161/01.str.0000064840.99271.9e] [Citation(s) in RCA: 229] [Impact Index Per Article: 10.9] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
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35
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Melgar MA, Weinand ME. Thyrocervical trunk–external carotid artery bypass for positional cerebral ischemia due to common carotid artery occlusion. Neurosurg Focus 2003; 14:e7. [PMID: 15709724 DOI: 10.3171/foc.2003.14.3.8] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Medically refractory positional cerebral ischemia and concomitant orthostatic hypotension associated with chronic common carotid artery (CCA) occlusion are rare. The authors detail their experience with three cases treated exclusively by an extracranial bypass in which the thyrocervical trunk was used as the donor vessel. Postoperatively grafts were patent and symptoms resolved in all three patients, although orthostatic hypotension remained. Postural cerebral ischemia due to CCA occlusion can be treated by extracranial bypass surgery. The thyrocervical trunk is a suitable donor for reconstruction of the external carotid artery in these cases.
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Affiliation(s)
- Miguel A Melgar
- Division of Neurosurgery, University of Arizona College of Medicine, Tucson, USA.
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Fujimoto S, Hasegawa Y, Yokota C, Tagaya M, Hayashida K, Yamaguchi T, Minematsu K. Acetazolamide challenge test using semiquantitative 123 I-IMP SPECT for detection of cerebral misery perfusion. J Neurol Sci 2002; 205:21-7. [PMID: 12409179 DOI: 10.1016/s0022-510x(02)00244-7] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The accuracy of the acetazolamide (ACZ) challenge test using semiquantitative SPECT in detecting Stage II hemodynamic failure, i.e. cerebral misery perfusion, in patients so diagnosed with PET has yet to be determined. This study was carried out in 53 patients who had a unilateral occlusion or severe stenosis of their cerebral artery. Asymmetry index (AI) was used to determine relative CBF distribution on each SPECT image. DeltaAI (regional vasodilatory capacity) values were compared with the values of several PET parameters. We also repeated SPECT and PET studies in 15 patients after a mean interval of 2.6 years from entry. The correlation between changes in DeltaAI and PET data were examined. The DeltaAI value closely correlated with the ipsilateral OEF value (r=-0.64, p<0.001). Sensitivity-specificity curve analysis revealed that the optimal cut-off value for detecting Stage II hemodynamic failure was -13.5% of DeltaAI, at which point the diagnostic accuracy was 82%. In follow-up studies, changes in DeltaAI correlated significantly with changes in OEF values (r=-0.68, p<0.01). Semiquantitative SPECT examination with ACZ challenge detects Stage II hemodynamic failure with a diagnostic accuracy of 82%. An improvement in reduced vasodilatory capacity as determined by SPECT coincides with a reduction in OEF values.
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Affiliation(s)
- Shigeru Fujimoto
- Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5-7-1 Fujishirodai, Suita, Osaka 565-8565, Japan
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Ogasawara K, Ogawa A, Terasaki K, Shimizu H, Tominaga T, Yoshimoto T. Use of cerebrovascular reactivity in patients with symptomatic major cerebral artery occlusion to predict 5-year outcome: comparison of xenon-133 and iodine-123-IMP single-photon emission computed tomography. J Cereb Blood Flow Metab 2002; 22:1142-8. [PMID: 12218420 DOI: 10.1097/00004647-200209000-00012] [Citation(s) in RCA: 59] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
The aim of this prospective study was to investigate whether decreased cerebrovascular reactivity to acetazolamide, as determined by single-photon emission computed tomography (SPECT), is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion. Cerebrovascular reactivity to acetazolamide in the middle cerebral artery (MCA) territory ipsilateral to the occluded artery was determined on the basis of two different methodologies: cerebral blood flow (CBF) percent change obtained quantitatively from xenon-133 (133Xe) SPECT, and asymmetry index (AI) percent change obtained qualitatively from N-isopropyl-p-[123I]-iodoamphetamine (IMP) SPECT. Seventy patients with unilateral internal carotid artery or MCA occlusion were divided into two groups within each SPECT methodology (normal or decreased CBF percent change and AI percent change) and followed up for 5 years. Cumulative recurrence-free survival rates for patients with decreased CBF percent change were significantly lower than for those with normal CBF percent change (P = 0.0205). There was no significant difference in cumulative recurrence-free survival rates between patients with decreased AI percent change and those with normal AI percent change. Only decreased CBF percent change was a significant independent predictor of stroke recurrence (P = 0.0051). The present study demonstrated that decreased cerebrovascular reactivity to acetazolamide determined quantitatively by 133Xe SPECT is an independent predictor of the 5-year risk of subsequent stroke in patients with symptomatic major cerebral artery occlusion, and that the qualitative method using 123I-IMP SPECT is a poor predictor of the risk of subsequent stroke in this type of patient.
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Affiliation(s)
- Kuniaki Ogasawara
- Department of Neurosurgery, Iwate Medical University, Morioka, Japan.
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Ogasawara K, Ogawa A, Yoshimoto T. Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion: a xenon-133 single-photon emission computed tomography study. Stroke 2002; 33:1857-62. [PMID: 12105366 DOI: 10.1161/01.str.0000019511.81583.a8] [Citation(s) in RCA: 185] [Impact Index Per Article: 8.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The present study prospectively evaluated relationships among baseline characteristics, cerebral hemodynamics, and outcome of patients with symptomatic major cerebral artery occlusion, by quantitative measurement of cerebral blood flow using xenon-133 (133Xe) inhalation and single-photon emission computed tomography (SPECT). METHODS Regional cerebrovascular reactivity (rCVR) to acetazolamide was calculated at entry to the study using 133Xe SPECT. Seventy consecutive patients aged less than 70 years with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion were divided into 2 groups: normal or reduced rCVR, and prospectively followed up for a period of 24 months. RESULTS During the follow-up period, recurrent strokes occurred in 8 of the 23 patients with reduced rCVR at entry and in 3 of 47 patients with normal rCVR. Cumulative recurrence-free survival rates in all patients, and in each subgroup of patients with ICA or MCA occlusion and reduced rCVR on entry, were significantly lower than in those with normal rCVR (P=0.0030, P=0.0404, and P=0.0310, respectively; Kaplan-Meier analysis). Among the factors considered, only lower rCVR and resting regional cerebral blood flow values were significantly associated with the risk of stroke recurrence (P=0.0019 and P=0.0080, respectively; Cox regression multivariate analysis). CONCLUSIONS The present study demonstrated that reduced rCVR to acetazolamide as determined by 133Xe SPECT is significantly associated with an increased risk of stroke recurrence in patients with symptomatic MCA or ICA occlusion.
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Affiliation(s)
- Kuniaki Ogasawara
- Department of Neurosurgery and Cyclotron Research Center, Iwate Medical University, Morioka, Japan.
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Bilecen D, Radü EW, Schulte AC, Hennig J, Scheffler K, Seifritz E. fMRI of the auditory cortex in patients with unilateral carotid artery steno-occlusive disease. J Magn Reson Imaging 2002; 15:621-7. [PMID: 12112511 DOI: 10.1002/jmri.10117] [Citation(s) in RCA: 16] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
PURPOSE To examine whether an internal carotid artery (ICA) steno-occlusive disease leads to a reduced blood oxygenation level dependent (BOLD)-signal change due to a decreased vasodilatory reserve capacity. MATERIALS AND METHODS Patients suffering from unilateral ICA stenosis or occlusion were examined using functional magnetic resonance imaging (fMRI) of the auditory cortex with a bilateral stimulation applying a pulsed 1000 Hz sine-tone. RESULTS Compared to control subjects, who showed symmetric bilateral BOLD-responses within the auditory cortex, the ICA patients revealed either a normal bilateral cortical activation pattern or a reduced cortical activation on the steno-occluded side. This latter decrease of BOLD-signal change might indicate a depressed vasomotor reserve capacity. The observed coincidence between this asymmetric reduction in BOLD-signal and ischemic borderzone lesions on the affected side in this subgroup of patients strongly supports this assumption. CONCLUSION This study shows that fMRI of the auditory cortex appears to have clinical merit in the workup of cerebrovascular conditions.
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Affiliation(s)
- Deniz Bilecen
- Neuroradiology Section, Department of Diagnostic Radiology, University of Basel, Switzerland.
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Kuroda S, Houkin K, Kamiyama H, Mitsumori K, Iwasaki Y, Abe H. Long-term prognosis of medically treated patients with internal carotid or middle cerebral artery occlusion: can acetazolamide test predict it? Stroke 2001; 32:2110-6. [PMID: 11546904 DOI: 10.1161/hs0901.095692] [Citation(s) in RCA: 242] [Impact Index Per Article: 10.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE The importance of hemodynamic parameters for predicting outcome in patients with occlusive carotid disease remains controversial. The present study was aimed at testing the hypothesis that regional cerebrovascular reactivity (rCVR) to acetazolamide can be a reliable predictor of subsequent ischemic stroke in medically treated patients with internal carotid artery or middle cerebral artery occlusion. METHODS Seventy-seven symptomatic patients were enrolled in this prospective, longitudinal cohort study. All patients met inclusion criteria of cerebral angiography, no or localized cerebral infarction on MRI or CT, and no or minimal neurological deficit. Regional cerebral blood flow (rCBF) and rCVR to acetazolamide were quantitatively determined by (133)Xe SEPCT. All patients were categorized into 4 types on the basis of SPECT studies. RESULTS During an average follow-up period of 42.7 months, 16 total and 7 ipsilateral ischemic strokes occurred. The annual risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were 35.6% and 23.7%, respectively, risks that are higher than those in other types of patients. When strokes were categorized into patients with and without decreased rCBF and rCVR, Kaplan-Meier analysis revealed that the risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were significantly higher than in those without (P<0.0001 and P=0.0001, respectively, log-rank test). Relative risk conferred by decreased rCBF and rCVR was 8.0 (95% CI, 1.9 to 34.4) for ipsilateral stroke and 3.6 (95% CI, 1.4 to 9.3) for total stroke. CONCLUSIONS Decreased rCBF and rCVR to acetazolamide may identify a subgroup of patients who have a higher risk of subsequent ischemic stroke when treated medically.
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Affiliation(s)
- S Kuroda
- Department of Neurosurgery, Hokkaido University Graduate School of Medicine, Hokkaido Neurosurgical Memorial Hospital, Sapporo, Japan
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Nemoto EM, Yonas H. Revisiting the question, "is the acetazolamide test valid for quantitative assessment of maximal cerebral autoregulatory vasodilation?". Stroke 2001; 32:1234-7. [PMID: 11340242 DOI: 10.1161/01.str.32.5.1234-d] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Mori T, Fukuoka M, Kazita K, Mima T, Mori K. Intraventricular hemorrhage after carotid stenting. JOURNAL OF ENDOVASCULAR SURGERY : THE OFFICIAL JOURNAL OF THE INTERNATIONAL SOCIETY FOR ENDOVASCULAR SURGERY 1999. [PMID: 10893135 DOI: 10.1583/1074-6218(1999)006<0337:ihacs>2.0.co;2] [Citation(s) in RCA: 29] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/26/2022]
Abstract
PURPOSE To report an important complication related to carotid stenting. METHODS AND RESULTS A 71-year-old man with symptomatic subtotal occlusion of the left internal carotid artery had a 30-mm lesion treated percutaneously with implantation of 2 stents. Although the procedure was completed satisfactorily, left intraventricular hemorrhage occurred 4 hours later, possibly related to hyperperfusion injury. The patient expired 30 days after the stent procedure. Preoperative single-photon emission computed tomography revealed severely reduced vasoreactivity in the affected territory after acetazolamide challenge. CONCLUSIONS The risk of hyperperfusion injury must be considered and minimized in patients with significant restriction of regional vasoreactivity. We recommend that cerebral hemodynamic status be determined prior to carotid stenting.
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Affiliation(s)
- T Mori
- Department of Neurosurgery, Kochi Medical School Hospital, Okoutyo, Nankoku City, Japan.
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Feldmann E, Skolnick BE. Cerebral hemodynamics, autoregulation, and blood pressure management. J Stroke Cerebrovasc Dis 1999; 8:176-82. [PMID: 17895161 DOI: 10.1016/s1052-3057(99)80024-x] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Affiliation(s)
- E Feldmann
- Department of Neurology, Brown University, Providence, RI, USA; Penn Neurological Institute at Pennsylvania Hospital, University of Pennsylvania Health System, Philadelphia, PA, USA
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Effect of Acetazolamide Reactivity and Long-term Outcome in Patients With Major Cerebral Artery Occlusive Diseases. Stroke 1998. [DOI: 10.1161/str.29.8.1742/a] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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