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(Stroke. 1995;26:1572-1576.)
© 1995 American Heart Association, Inc.

Articles

Effect of Adenosine on Cerebral Blood Flow as Evaluated by Single-Photon Emission Computed Tomography in Normal Subjects and in Patients With Occlusive Carotid Disease

A Comparison With Acetazolamide

Andrea Soricelli, MD; Alfredo Postiglione, MD; Alberto Cuocolo, MD; Simona De Chiara, MD; Antonio Ruocco, MD; Arturo Brunetti, MD; Marco Salvatore, MD Peter J. Ell, MD

From the Nuclear Medicine Unit, Medical School, "Federico II" University, National Cancer Institute "G. Pascale," and Nuclear Medicine Center of the National Council of Research (A.S., A.C., A.B., M.S.), and the Institute of Internal Medicine and Metabolic Diseases, Medical School, "Federico II" University (A.P., S. De C., A.R.), Naples, Italy; and the Institute of Nuclear Medicine, University College and Middlesex School of Medicine, London, UK (P.J.E.).

Correspondence to Andrea Soricelli, MD, Servizio di Medicina Nucleare, Facoltà di Medicina e Chirurgia, Università degli Studi "Federico II," via S Pansini 5, 80131 Naples, Italy.

Background and Purpose Acetazolamide is commonly used with single-photon CT to assess the cerebrovascular reserve in patients with internal carotid artery stenosis or occlusion. In this study we wanted to evaluate the effects of adenosine, a well-known vasodilatatory compound with a short biological half-life, on brain circulation in humans and compare the results with those of acetazolamide.

Methods Acetazolamide (1 g) and adenosine (140 µg/kg per minute) were injected intravenously on different days in 6 normal subjects and 6 patients: 4 with unilateral stenosis, 1 with bilateral stenosis, and 1 with complete occlusion of the internal carotid artery. Changes in regional cerebral blood flow relative to that of the cerebellum (cortico/cerebellar ratios) from resting conditions were evaluated by ^99mTc–hexamethylpropyleneamine oxime and single-photon emission CT.

Results The measured blood flow ratios increased significantly in the normal group 20 minutes after acetazolamide injection in several cortical and subcortical regions, as well as at the 4th minute of a 6-minute adenosine infusion. Regional cerebral blood flow ratio values were higher after adenosine than after acetazolamide in both cortical (frontal and parietal) and subcortical (thalamus and basal ganglia) regions. In 4 of the 6 patients the side-to-side asymmetry increased from the basal resting condition after the injection of acetazolamide and even more so after the injection of adenosine.

Conclusions Adenosine infusion causes vasodilatation of cerebral arteries and can be used for the investigation of cerebrovascular perfusion capacity in patients with carotid occlusive disease. One advantage in the use of adenosine over acetazolamide is the possibility of interrupting the test with reversal of clinical symptoms or patient discomfort within a few minutes.

Key Words: acetazolamide • adenosine • carotid artery diseases • tomography, emission-computed • cerebral blood flow

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