From the Cerebrovascular Division, Department of Medicine, National
Cardiovascular Center, Osaka, Japan.
Correspondence to Chiaki Yokota, MD, Cerebrovascular Division, Department of Medicine, National Cardiovascular Center, 5–7-1 Fujishiro-dai, Suita, Osaka 565, Japan.
Background and Purpose—It remains
unclear whether hemodynamic insufficiency plays a major
role in ischemic events. We performed a prospective follow-up
study in ischemic stroke patients with occlusive large-artery
diseases to determine whether stroke recurrence is related to
reduced vasodilatory capacity, judged with single-photon emission CT
and acetazolamide (ACZ) challenge.
Methods—During the period from 1987 to 1995, we examined cerebral
vasodilatory capacity with single-photon emission CT and an ACZ
challenge in 105 consecutive stroke patients with severe
stenosis (>75% in diameter) or occlusion of the internal
carotid artery or the trunk of the middle cerebral artery who had no or
minimal infarcts on CT. According to criteria reported earlier, the
patients were divided into two groups: normal (negative ACZ, n=50) or
reduced ACZ reactivity (positive ACZ, n=55). They were prospectively
followed at regular intervals for a median period of 2.7 years.
Results—The Kaplan-Meier analysis revealed no difference
in cumulative recurrence-free survival rate between the two
groups. The multivariate analysis with Cox
proportional hazards model demonstrated that a high systolic
blood pressure at entry into the study significantly increased stroke
recurrence (coefficient=.0466; hazard ratio=1.0477; 95%
confidence interval=1.0017 to 1.0957; P=.04), whereas
antihypertensive medication significantly reduced stroke
recurrence (coefficient=-1.527; hazard ratio=0.217; 95%
confidence interval=0.0612 to 0.771; P=.02), but no
other variables including ACZ reactivity affected stroke
recurrence rate.
Conclusions—The present results demonstrate that reduced
vasodilatory capacity does not play a major role in stroke
recurrence. Antihypertensive therapy appears to reduce stroke
recurrence even in patients with
hemodynamically significant arterial
diseases.
© 1998 American Heart Association, Inc.
Original Contributions
Effect of Acetazolamide Reactivity and Long-term Outcome in Patients With Major Cerebral Artery Occlusive Diseases
Key Words: acetazolamide • hemodynamics • tomography, emission computed • vasodilation
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