Outcome of Carotid Artery Occlusion Is Predicted by Cerebrovascular Reactivity

Abstract

Background and Purpose-The purpose of this study was to investigate the possibility of obtaining prognostic indications in patients with internal carotid occlusion on the basis of intracranial hemodynamic status, presence of previous symptoms of cerebrovascular failure, and baseline characteristics. Methods-Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. Cerebrovascular reactivity to apnea was calculated by means of the breath-holding index (BHI) in the middle cerebral arteries. Sixty-five patients with internal carotid artery occlusion were followed-up prospectively (median, 24 months), 23 patients were asymptomatic and 42 symptomatic (20 with transient ischemic attack and 22 with stroke). Results-During the follow-up period, 11 symptomatic patients and 1 asymptomatic patient had another ischemic event ipsilateral to carotid occlusion. Among factors considered, only lower BHI values in the middle cerebral arteries ipsilateral to carotid occlusion and older age were significantly associated with the risk of developing symptoms (Pϭ0.002 and Pϭ0.003, respectively; Cox regression multivariate analysis). Based on our data, a cut point of the BHI value for distinguishing between pathological and normal cerebrovascular reactivity was determined to be 0.69. All patients except one, who developed TIA or stroke during the follow-up period, had BHI values ipsilateral to carotid occlusion of Ͻ0.69. Conclusions-These data suggest that impaired cerebrovascular reactivity is predictive for cerebral ischemic events in patients with carotid occlusion. (Stroke. 1999;30:593-598.)

Change in Cerebral Perfusion after Carotid Angioplasty with Stenting Is Related to Cerebral Vasoreactivity: A Study Using Dynamic Susceptibility-Weighted Contrast-Enhanced MR Imaging and Functional MR Imaging with a Breath-Holding Paradigm

“…Although the major cause of stroke in patients with severe arterial stenosis or occlusion is thought to be thromboembolism, the hemodynamic compromise also plays an important role. 23,36 A recent study retrospectively analyzed the patterns of infarction in patients with carotid occlusion and hemodynamic failure, and the data suggested a synergistic effect between thromboembolic and hemodynamic mechanisms for the ischemic stroke. 37 Furthermore, impaired CVR may predict stroke or TIA risk in patients with either asymptomatic or symptomatic carotid stenosis.…”

Calibrated MRI to Evaluate Cerebral Hemodynamics in Patients with an Internal Carotid Artery Occlusion

“…1,3 Impaired CVR is a predictor for increased risk of ipsilateral stroke and transient ischemic attack (TIA) in patients with steno-occlusive carotid disease. 4,5 Similarly, increased OEF has been shown to predict recurrent ischemic stroke in patients with symptomatic occlusive disease of the cerebral vasculature. 6 Furthermore, a higher stroke risk has been observed in patients with impaired CVR and increased OEF when compared with patients with impaired CVR only.…”

Tissue Pulsatility Imaging of Cerebral Vasoreactivity During Hyperventilation

“…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).…”