Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease

Webster, Marshall W.; Makaroun, Michel S.; Steed, David L.; Smith, Holly A.; Johnson, David W.; Yonas, Howard

doi:10.1016/s0741-5214(95)70274-1

Cited by 241 publications

(125 citation statements)

References 16 publications

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“…The mechanism for this, the CVR, secures the delivery of oxygen to the parenchyma of the brain. Recently it was shown that a diminished CVR is a predictor of stroke in patients with symptomatic carotid artery occlusive disease (16). Furthermore, cerebral periventricular white matter lesions have been found to be correlated with decreased vasomotor reactivity in asymptomatic individuals (17), increased stroke risk (18), first-ever lacunar infarction (19), and deep white matter lesions (20).…”

Section: Discussionmentioning

confidence: 99%

MR assessment of cerebral vascular response: A comparison of two methods

Spilt

Boom

Kamper

et al. 2002

Magnetic Resonance Imaging

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Purpose:To compare the results and reproducibility of two MR-based methods of measuring the cerebrovascular response (CVR). Materials and Methods:In eight volunteers, CVR was assessed with two MR-based methods upon a challenge with acetazolamide. CVR was assessed by measuring changes in total cerebral blood flow (TCBF) using phase contrast (PC) MRI, and by measuring perfusion MRI. To assess reproducibility the measurements were repeated after 1 week. Results:The average CVR with the PC-MRI method was 46% (SD ϭ 16%), and for perfusion MR the measured CVR was 44% (SD ϭ 16%). The coefficient of variation (COV) for PC-MRI was 28%, while perfusion MR had a COV of 26%. The limits of agreement between the two methods were -49% and 45%, demonstrating a lack of agreement between the two methods in terms of CVR estimation. Conclusion:CVR estimates based on PC-MRI and perfusion MRI showed reproducibility but a lack of agreement in healthy volunteers. This lack of agreement can be attributed to the different aspects of the CVR reflected by these methods: TCBF reflects changes in CBF, whereas our perfusion MRI method reflects cerebral blood volume (CBV).

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Section: Discussionmentioning

confidence: 99%

MR assessment of cerebral vascular response: A comparison of two methods

Spilt

Boom

Kamper

et al. 2002

Magnetic Resonance Imaging

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“…Measurement of CVR has been used to evaluate cerebral vascular function over a broad range of clinical applications including to monitor the severity of brain damage after an ischemic event (Dohmen et al 2007), to predict the risk of a cerebral ischemic event in patients with carotid occlusive disease (Diehl 2002;Kleiser and Widder 1992;Markus and Cullinane 2001;Vernieri et al 1999, Webster et al 1995Yonas et al 1993), to assess the efficacy of a carotid endarterectomy (Herzig et al 2004), and to study anxiety disorders (Giardino et al 2007;Mathew and Wilson 1997) and migraine attacks (Akin and Bilensoy 2006).…”

Section: Introductionmentioning

confidence: 99%

Tissue Pulsatility Imaging of Cerebral Vasoreactivity During Hyperventilation

Kucewicz

Dunmire

Giardino

et al. 2008

Ultrasound in Medicine & Biology

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Tissue Pulsatility Imaging (TPI) is an ultrasonic technique that is being developed at the University of Washington to measure tissue displacement or strain due to blood flow over the cardiac and respiratory cycles. This technique is based in principle on plethysmography, an older non-ultrasound technology for measuring expansion of a whole limb or body part due to perfusion. TPI adapts tissue Doppler signal processing methods to measure the "plethysmographic" signal from hundreds or thousands of sample volumes in an ultrasound image plane. This paper presents a feasibility study to determine if TPI can be used to assess cerebral vasoreactivity. Ultrasound data were collected transcranially through the temporal acoustic window from four subjects before, during, and after voluntary hyperventilation. In each subject, decreases in tissue pulsatility during hyperventilation were observed that were statistically correlated with the subject's end-tidal CO 2 measurements.

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“…Steal phenomenon is a risk factor for future ischemic stroke. 1,2 In patients with Moyamoya disease, a progressive narrowing of the supraclinoid internal carotid artery (ICA) and its proximal branches, negative or severely reduced CVR has been used to identify patients who may benefit from surgical revascularization. 3,4 However, the impact of steal phenomenon on normal-appearing brain tissue (ie, in the absence of overt infarction) has not been previously investigated.…”

mentioning

confidence: 99%

Impaired Cerebrovascular Reactivity With Steal Phenomenon Is Associated With Increased Diffusion in White Matter of Patients With Moyamoya Disease

Conklin

Fierstra

Crawley

et al. 2010

Stroke

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Background and Purpose-Reduced cerebrovascular reactivity (CVR) with steal phenomenon is an independent predictor for stroke and may indicate tissue exposed to episodic low-grade ischemia. The apparent diffusion coefficient (ADC) calculated using diffusion-weighted MRI is effective in characterizing focal brain ischemia and subtle structural changes in normal-appearing white matter (WM). We hypothesized that regions of steal phenomenon are associated with increased ADC in normal-appearing WM of patients with Moyamoya disease. Methods-Twenty-two patients with unilateral CVR impairment secondary to Moyamoya disease and 12 healthy control subjects underwent diffusion-weighted MRI and functional MRI mapping of the cerebrovascular response to hypercapnia. Parametric maps of ADC and CVR were calculated, coregistered, and segmented using automated image processing methods. ADC of normal-appearing WM was compared between hemispheres, and between WM with negative CVR (ie, steal phenomenon) and WM with positive CVR. Results-In patients, ADC of normal-appearing WM was elevated in the hemisphere ipsilateral to the CVR impairment compared with the contralateral hemisphere (PϽ0.005) and in WM with negative CVR compared with WM with positive CVR (PϽ0.001). WM in regions of steal phenomenon within the affected hemisphere had higher ADC than homologous contralateral WM (PϽ0.005). In control subjects, negative CVR in WM was not associated with elevated ADC. Conclusions-Regions

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Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease

Abstract: The loss of cerebral reactivity in patients with symptoms who had greater than or equal to 70% carotid stenosis or occlusion is an important predictor of impending cerebral infarction.

Cited by 241 publications

References 16 publications

MR assessment of cerebral vascular response: A comparison of two methods

MR assessment of cerebral vascular response: A comparison of two methods

Tissue Pulsatility Imaging of Cerebral Vasoreactivity During Hyperventilation

Impaired Cerebrovascular Reactivity With Steal Phenomenon Is Associated With Increased Diffusion in White Matter of Patients With Moyamoya Disease

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