(Stroke. 1996;27:617-621.)
© 1996 American Heart Association, Inc.
Articles |
Cerebral Blood Flow Alteration by Acetazolamide During Carotid Balloon Occlusion
Parameters Reflecting Cerebral Perfusion Pressure in the Acetazolamide Test
From the Department of Neurosurgery, Juntendo University, Tokyo, Japan.
Background and Purpose We attempted to clarify the role of the acetazolamide-reactive mechanism in cerebral hemodynamic autoregulation and to establish a useful method of estimation using the acetazolamide test.
Methods We examined 18 patients whose cerebral
hemodynamics were considered to be normal and whose
cerebral blood flow (CBF) was maintained during the balloon occlusion
test (BOT) of the internal carotid artery. We measured the mean stump
pressure (MSTP) and the mean CBF in the middle cerebral
arterial territory using a xenon-enhanced CT system
during BOT with and without acetazolamide activation. We
obtained the asymmetry ratio (AR=occluded CBF/contralateral CBF) and
the increased CBF parameters caused by
acetazolamide activation expressed as an absolute value
(
CBF) and a percentage (%CBF) for the occluded side.
Results AR during BOT with and without
acetazolamide activation differed significantly
(P<.001, paired t test) despite the lack of
significant MSTP changes. Furthermore, although there was no
significant correlation between MSTP and AR without
acetazolamide activation, a positive significant
correlation was detected with acetazolamide activation
(r=.634, P=.005, linear regression
analysis). There were significant correlations between CBF
and MSTP (r=.574, P=.013) and %CBF and MSTP
(r=.640, P=.004).
Conclusions We consider that the
acetazolamide-reactive mechanism functions as
autoregulation at the lower end of the autoregulatory range. The
acetazolamide test, using %CBF or CBF as
parameters (which both directly reflect MSTP), is useful
for estimating the cerebral perfusion pressure decrease and presence of
hemodynamic compromise.
Key Words: acetazolamide • autoregulation • carotid arteries • cerebral blood flow • xenon
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