Stroke, Vol 21, 1400-1406, Copyright © 1990 by American Heart Association
H Yamauchi, H Fukuyama, J Kimura, J Konishi and M Kameyama
Using positron emission tomography in nine patients with minor strokes,
unilateral internal carotid artery occlusion, and good collateral
circulation through the anterior portion of the circle of Willis, we
analyzed regional cerebral blood flow, cerebral metabolic rate of oxygen,
oxygen extraction fraction, and cerebral blood volume. These studies
allowed quantification of the regional hemodynamic status, especially in
relation to watershed areas. Compared with eight normal controls, the
patients had significantly (p less than 0.01) decreased regional cerebral
blood flow in the middle cerebral artery territory and the surrounding
watershed areas of the occluded hemisphere. The oxygen extraction fraction
rose with the distance from the anterior portion of the circle of Willis,
attaining the highest value in the superior parietal and posterior
temporo-occipital watershed area. A concomitant decrease in the cerebral
blood flow/cerebral blood volume ratio suggested reduction in the mean
blood flow velocity, whereby elevated blood viscosity would be more liable
to reduce cerebral blood flow. These findings suggest hemodynamic
vulnerability of the watershed areas after internal carotid artery
occlusion in persons with good collateral circulation through the anterior
portion of the circle of Willis. Our results also emphasize the importance
of systemic hemodynamic factors such as blood pressure and circulating
blood volume in the genesis of watershed infarction.
ARTICLES
Hemodynamics in internal carotid artery occlusion examined by positron emission tomography
Department of Neurology, Kyoto University School of Medicine, Japan.
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