This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Karnik, R. Articles by Slany, J. Search for Related Content PubMed PubMed Citation Articles by Karnik, R. Articles by Slany, J. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETAZOLAMIDE Medline Plus Health Information Carotid Artery Disease

Stroke, Vol 23, 812-817, Copyright © 1992 by American Heart Association

ARTICLES

Evaluation of vasomotor reactivity by transcranial Doppler and acetazolamide test before and after extracranial-intracranial bypass in patients with internal carotid artery occlusion

R Karnik, A Valentin, HP Ammerer, P Donath and J Slany
Department of Internal Medicine, Krankenanstalt Rudolfstiftung, Vienna, Austria.

BACKGROUND AND PURPOSE: The aim of this trial was to evaluate the effectiveness of extracranial-intracranial bypass with respect to vasomotor reactivity in patients with internal carotid artery occlusions and absent vasomotor reactivity, comparing them with a control group treated conservatively. METHODS: To test vasomotor reactivity in 104 patients with unilateral occlusion of the internal carotid artery, we measured blood flow velocity in the middle cerebral artery by transcranial Doppler sonography both at rest and after injection of acetazolamide. Among the 39 patients who failed to show increased mean blood flow velocity after the acetazolamide test distal to an occluded internal carotid artery by greater than or equal to 10%, 14 subjects subsequently underwent extracranial-intracranial bypass surgery (group A) and 14 age- and sex-matched subjects in whom no such procedure was done composed the control group (group B). Follow-up examinations were performed 3-6 months postoperatively and in the control group 3-6 months after initial examination. RESULTS: Baseline values of the mean blood flow velocity at rest on the affected side were reduced in both groups compared with the contralateral healthy side (group A, 46.0 +/- 15.1 cm/sec; group B, 48.1 +/- 16.7 cm/sec) and revealed only a marginal increase after acetazolamide. The contralateral side showed a normal blood flow velocity at rest and an adequate response to acetazolamide in both groups. On the follow-up examination group A demonstrated a normalized vasodilatory capacity. Blood flow velocity increased significantly after acetazolamide from 41.9 +/- 13.1 cm/sec to 53.5 +/- 16.0 cm/sec (p less than 0.002). In group B, the compromised vasomotor reactivity remained unchanged. CONCLUSIONS: Our results demonstrate that transcranial Doppler sonography together with the acetazolamide test can identify subjects with reduced vasomotor reactivity distal to an occluded internal carotid artery, who may improve hemodynamically by an extracranial- intracranial bypass.

This article has been cited by other articles:

				M.B. Sanchez-Arjona, G. Sanz-Fernandez, E. Franco-Macias, and A. Gil-Peralta Cerebral Hemodynamic Changes after Carotid Angioplasty and Stenting AJNR Am. J. Neuroradiol., April 1, 2007; 28(4): 640 - 644. [Abstract] [Full Text] [PDF]

				C. J.M. Klijn, L. J. Kappelle, A. van der Zwan, J. van Gijn, and C. A.F. Tulleken Excimer Laser-Assisted High-Flow Extracranial/Intracranial Bypass in Patients With Symptomatic Carotid Artery Occlusion at High Risk of Recurrent Cerebral Ischemia: Safety and Long-Term Outcome Stroke, October 1, 2002; 33(10): 2451 - 2458. [Abstract] [Full Text] [PDF]

				M. Rohrberg and R. Brodhun Measurement of Vasomotor Reserve in the Transcranial Doppler-CO2 Test Using an Ultrasound Contrast Agent (Levovist) Stroke, June 1, 2001; 32(6): 1298 - 1303. [Abstract] [Full Text] [PDF]

				F. Vernieri, P. Pasqualetti, F. Passarelli, P. M. Rossini, and M. Silvestrini Outcome of Carotid Artery Occlusion Is Predicted by Cerebrovascular Reactivity Stroke, March 1, 1999; 30(3): 593 - 598. [Abstract] [Full Text] [PDF]

				R. Karnik, A. Valentin, W.-B. Winkler, N. Khaffaf, P. Donath, and J. Slany Sex-Related Differences in Acetazolamide-Induced Cerebral Vasomotor Reactivity Stroke, January 1, 1996; 27(1): 56 - 58. [Abstract] [Full Text]

				A. Kleinschmidt, H. Steinmetz, M. Sitzer, K.-D. Merboldt, and J. Frahm Magnetic Resonance Imaging of Regional Cerebral Blood Oxygenation Changes Under Acetazolamide in Carotid Occlusive Disease Stroke, January 1, 1995; 26(1): 106 - 110. [Abstract] [Full Text]