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Stroke, Vol 25, 1963-1967, Copyright © 1994 by American Heart Association
B Widder, B Kleiser and H Krapf
BACKGROUND AND PURPOSE: Patients with internal carotid artery occlusions
and highly impaired cerebrovascular reactivity have been identified as
having an increased risk of stroke. It is still unclear, however, whether
cerebral hemodynamics may be restored in the course of time by the
development of collaterals. METHODS: During a 5-year period we assessed
cerebrovascular reactivity in 452 carotid occlusions by transcranial
Doppler CO2 testing. Ninety-eight patients could be reinvestigated at least
once after 2 to 58 months (mean follow-up time, 26 months). RESULTS: On
admission, patients with recent transient ischemic attack or stroke (<
or = 3 months) as well as patients with contralateral carotid stenoses of
80% diameter reduction or greater and occlusions revealed a significantly
higher incidence of impaired CO2 reactivity (P < .0001 and P < .01,
respectively). During follow-up, 64% of the patients with no or minor
contralateral carotid stenoses, but only 22% of the patients with bilateral
carotid occlusions, showed a spontaneous improvement in cerebrovascular
reactivity (P < .001), mainly during the first few months. In six of
eight patients cerebral hemodynamics on the occluded side improved after
endarterectomy of a contralateral high-grade carotid stenosis. Five of the
patients who did not undergo surgery developed a stroke during follow-up,
with three of them occurring in patients with permanently exhausted
cerebrovascular reactivity. CONCLUSIONS: In the majority of patients with
carotid occlusions an initially impaired cerebrovascular reactivity
improves spontaneously with time. This could influence therapeutic
decisions: During the first few months antihypertensive treatment may be
avoided in such cases until a reestablished reactivity can be demonstrated.
If cerebral hemodynamics remain depleted, extracranial-intracranial bypass
surgery or endarterectomy of an asymptomatic contralateral high-grade
carotid stenosis could be helpful.
ARTICLES
Course of cerebrovascular reactivity in patients with carotid artery occlusions
Department of Neurology, University of Ulm, Germany.
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