Morphometric evaluation of the delayed cerebral arteries response to acetazolamide test in patients with chronic carotid artery stenosis using computed tomography angiography

Szarmach, Arkadiusz; Winklewski, Paweł J.; Halena, Grzegorz; Kaszubowski, Mariusz; Dzierżanowski, Jarosław; Piskunowicz, Maciej; Szurowska, Edyta; Frydrychowski, Andrzej F.

doi:10.5603/fm.a2016.0034

Cited by 4 publications

(6 citation statements)

References 18 publications

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“…The MTT in the frontal, parietal and temporal cortices grey matter was within the normal range (3-5 s), suggesting relatively balanced circulation and perfusion pressure (Schumann et al, 1988;Murphy et al, 2011). The moderate CBF decline in subjects with chronic carotid stenosis is in line with other reports by our team and others (Szarmach et al, 2017a;Szarmach et al, 2017b;Niesen et al, 2004;Trojanowska et al, 2006).…”

Section: Resting Statesupporting

confidence: 88%

“…Delayed acetazolamide test might be better suited for elderly subjects with several cardiovascular diseases and most likely diminished CVR. To the best of our knowledge our team is the first to show that the acetazolamide effect persists for at least 60 minutes in subjects with chronic carotid artery stenosis (Szarmach et al, 2017a). There is accumulating evidence that CVR should be seen as a process of temporally and spatially defined dynamics rather than a single value based on measurement at the point of the highest response (Bhogal et al, 2014;Bhogal et al, 2015;Bhogal et al, 2016).…”

Section: Delayed Acetazolamide Testmentioning

confidence: 97%

“…The number of studied subjects involved in the study is relatively small and heterogeneous in terms of medical history, including previous history of stroke, carotid artery endarterectomy and stenting. The study population is nevertheless representative for a group of patients with chronic carotid artery stenosis (Szarmach et al, Szarmach et al, 2016;Szarmach et al, 2017a;Szarmach et al, 2017b). Moreover, the study group is very homogeneous with respect to low CBV and CBF values due to strict inclusion criteria (carotid stenosis >90% on the ipsilateral side, less than 50% on the contralateral side, complete circle of Willis and normal vertebral arteries).…”

Section: Delayed Acetazolamide Testmentioning

confidence: 99%

“…However, the response to the acetazolamide test seems to be delayed in stenosed territories (Murakami et al, 2002;Hartkamp et al, 2012). One of our recent studies suggests that morphometric changes in the diameter of arteries originating from the circle of Willis are present even 60 minutes after the acetazolamide test (Szarmach et al, 2017a). Therefore a delayed response to vasodilatory challenge appears to provide important pathophysiological information.…”

Section: Introductionmentioning

confidence: 99%

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Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis

et al. 2018

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The aim of this study was to assess regional perfusion at baseline and regional cerebrovascular resistance (CVR) to delayed acetazolamide challenge in subjects with chronic carotid artery stenosis.Sixteen patients (ten males) aged 70.94±7.71 with carotid artery stenosis ≥90% on the ipsilateral side and ≤50% on the contralateral side were enrolled into the study. In all patients, two computed tomography perfusion examinations were carried out; the first was performed before acetazolamide administration and the second 60 minutes after injection.The differences between mean values were examined by paired two-sample t-test and alternative nonparametric Wilcoxon’s test. Normality assumption was examined using W Shapiro-Wilk test.The lowest resting-state cerebral blood flow (CBF) was observed in white matter (ipsilateral side: 18.4±6.2; contralateral side: 19.3±6.6) and brainstem (ipsilateral side: 27.8±8.5; contralateral side: 29.1±10.8). Grey matter (cerebral cortex) resting state CBF was below the normal value for subjects of this age: frontal lobe – ipsilateral side: 30.4±7.0, contralateral side: 33.7±7.1; parietal lobe – ipsilateral side: 36.4±11.3, contralateral side: 42.7±9.9; temporal lobe – ipsilateral side: 32.5±8.6, contralateral side: 39.4±10.8; occipital lobe – ipsilateral side: 24.0±6.0, contralateral side: 26.4±6.6). The highest resting state CBF was observed in the insula (ipsilateral side: 49.2±17.4; contralateral side: 55.3±18.4). A relatively high resting state CBF was also recorded in the thalamus (ipsilateral side: 39.7±16.9; contralateral side: 41.7±14.1) and cerebellum (ipsilateral side: 41.4±12.2; contralateral side: 38.1±11.3). The highest CVR was observed in temporal lobe cortex (ipsilateral side: +27.1%; contralateral side: +26.1%) and cerebellum (ipsilateral side: +27.0%; contralateral side: +34.6%). The lowest CVR was recorded in brain stem (ipsilateral side: +20.2%; contralateral side: +22.2%) and white matter (ipsilateral side: +18.1%; contralateral side: +18.3%). All CBF values were provided in milliliters of blood per minute per 100 g of brain tissue [ml/100g/min]. Resting state circulation in subjects with carotid artery stenosis is low in all analysed structures with the exception of insula and cerebellum. Acetazolamide challenge yields relatively uniform response in both hemispheres in the investigated population.Grey matter is more reactive to acetazolamide challenge than white matter or brainstem.

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Section: Resting Statesupporting

confidence: 88%

Section: Delayed Acetazolamide Testmentioning

confidence: 97%

Section: Delayed Acetazolamide Testmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis

et al. 2018

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“…Contralateral CBF was slightly higher and MTT lower in the all-slices analysis, tentatively suggesting better preserved circulation on the contralateral side. The contralateral artery remains the main route for collateral flow, as the reactivity of the posterior cerebral artery is much lower in subjects with chronic internal carotid artery stenosis [35]. In most studies, CBV after carotid artery stenting did not change [36,37,38].…”

Section: Discussionmentioning

confidence: 99%

Carotid Artery Stenting and Blood–Brain Barrier Permeability in Subjects with Chronic Carotid Artery Stenosis

Szarmach

Halena

Kaszubowski

et al. 2017

IJMS

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Failure of the blood-brain barrier (BBB) is a critical event in the development and progression of diseases such as acute ischemic stroke, chronic ischemia or small vessels disease that affect the central nervous system. It is not known whether BBB breakdown in subjects with chronic carotid artery stenosis can be restrained with postoperative recovery of cerebral perfusion. The aim of the study was to assess the short-term effect of internal carotid artery stenting on basic perfusion parameters and permeability surface area-product (PS) in such a population. Forty subjects (23 males) with stenosis of >70% within a single internal carotid artery and neurological symptoms who underwent a carotid artery stenting procedure were investigated. Differences in the following computed tomography perfusion (CTP) parameters were compared before and after surgery: global cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT), time to peak (TTP) and PS. PS acquired by CTP is used to measure the permeability of the BBB to contrast material. In all baseline cases, the CBF and CBV values were low, while MTT and TTP were high on both the ipsi- and contralateral sides compared to reference values. PS was approximately twice the normal value. CBF was higher (+6.14%), while MTT was lower (−9.34%) on the contralateral than on the ipsilateral side. All perfusion parameters improved after stenting on both the ipsilateral (CBF +22.66%; CBV +18.98%; MTT −16.09%, TTP −7.62%) and contralateral (CBF +22.27%, CBV +19.72%, MTT −14.65%, TTP −7.46%) sides. PS decreased by almost half: ipsilateral −48.11%, contralateral −45.19%. The decline in BBB permeability was symmetrical on the ipsi- and contralateral sides to the stenosis. Augmented BBB permeability can be controlled by surgical intervention in humans.

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Central sympathetic nervous system reinforcement in obstructive sleep apnoea

Wszędybył-Winklewska

Wolf

Szarmach

et al. 2018

Sleep Medicine Reviews

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Morphometric evaluation of the delayed cerebral arteries response to acetazolamide test in patients with chronic carotid artery stenosis using computed tomography angiography

Cited by 4 publications

References 18 publications

Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis

Regional resting state perfusion variability and delayed cerebrovascular uniform reactivity in subjects with chronic carotid artery stenosis

Carotid Artery Stenting and Blood–Brain Barrier Permeability in Subjects with Chronic Carotid Artery Stenosis

Central sympathetic nervous system reinforcement in obstructive sleep apnoea

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