(Stroke. 1999;30:593-598.)
© 1999 American Heart Association, Inc.
Original Contributions |
Outcome of Carotid Artery Occlusion Is Predicted by Cerebrovascular Reactivity
From the AFaR CRCCS: Divisione di Neurologia-Ospedale Fatebenefratelli, Isola Tiberina, Roma (F.V., P.P., F.P., P.M.R.); IRCCS "Centro S.Giovanni di Dio" FBF, Brescia (P.M.R.); and Clinica Neurologica, Università di Roma "Tor Vergata and IRCCS "S. Lucia," Roma (M.S.).
Correspondence to Dr Mauro Silvestrini, Clinica Neurologica, Università di Roma "Tor Vergata," Ospedale S.Eugenio, P.le dell'Umanesimo 10, 00144 Roma, Italy. E-mail fbfisola{at}tin.it
Background and Purpose—The purpose of this study was to investigate the possibility of obtaining prognostic indications in patients with internal carotid occlusion on the basis of intracranial hemodynamic status, presence of previous symptoms of cerebrovascular failure, and baseline characteristics.
Methods—Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. Cerebrovascular reactivity to apnea was calculated by means of the breath-holding index (BHI) in the middle cerebral arteries. Sixty-five patients with internal carotid artery occlusion were followed-up prospectively (median, 24 months), 23 patients were asymptomatic and 42 symptomatic (20 with transient ischemic attack and 22 with stroke).
Results—During the follow-up period, 11 symptomatic patients and 1 asymptomatic patient had another ischemic event ipsilateral to carotid occlusion. Among factors considered, only lower BHI values in the middle cerebral arteries ipsilateral to carotid occlusion and older age were significantly associated with the risk of developing symptoms (P=0.002 and P=0.003, respectively; Cox regression multivariate analysis). Based on our data, a cut point of the BHI value for distinguishing between pathological and normal cerebrovascular reactivity was determined to be 0.69. All patients except one, who developed TIA or stroke during the follow-up period, had BHI values ipsilateral to carotid occlusion of <0.69.
Conclusions—These data suggest that impaired cerebrovascular reactivity is predictive for cerebral ischemic events in patients with carotid occlusion.
Key Words: carotid occlusion • cerebrovascular circulation • stroke • ultrasonography, Doppler, transcranial
This article has been cited by other articles:
 |
|
 |
|
  A.S. Vagal, J.L. Leach, M. Fernandez-Ulloa, and M. Zuccarello The Acetazolamide Challenge: Techniques and Applications in the Evaluation of Chronic Cerebral Ischemia AJNR Am. J. Neuroradiol., May 1, 2009; 30(5): 876 - 884. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 F. Urbano, F. Roux, J. Schindler, and V. Mohsenin Impaired cerebral autoregulation in obstructive sleep apnea J Appl Physiol, December 1, 2008; 105(6): 1852 - 1857. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. J. Bos, P. J. Koudstaal, A. Hofman, J. C.M. Witteman, and M. M.B. Breteler Transcranial Doppler Hemodynamic Parameters and Risk of Stroke: The Rotterdam Study Stroke, September 1, 2007; 38(9): 2453 - 2458. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 N. Uzuner, S. Ozkan, and N. Cinar Cerebrovascular reactivity in multiple sclerosis patients Multiple Sclerosis, July 1, 2007; 13(6): 737 - 741. [Abstract] [PDF]
|
|
|
|
 |
|
 K. I. Paraskevas, D. P. Mikhailidis, and C. D. Liapis Internal Carotid Artery Occlusion: Association With Atherosclerotic Disease in Other Arterial Beds and Vascular Risk Factors Angiology, June 1, 2007; 58(3): 329 - 335. [Abstract] [PDF]
|
|
|
|
|
|
I. Momjian-Mayor and J.-C. Baron The Pathophysiology of Watershed Infarction in Internal Carotid Artery Disease: Review of Cerebral Perfusion Studies Stroke, March 1, 2005; 36(3): 567 - 577. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Ogasawara, T. Inoue, M. Kobayashi, H. Endo, K. Yoshida, T. Fukuda, K. Terasaki, and A. Ogawa Cerebral Hyperperfusion Following Carotid Endarterectomy: Diagnostic Utility of Intraoperative Transcranial Doppler Ultrasonography Compared with Single-Photon Emission Computed Tomography Study AJNR Am. J. Neuroradiol., February 1, 2005; 26(2): 252 - 257. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. Kamouchi, K. Kishikawa, Y. Okada, T. Inoue, S. Ibayashi, and M. Iida Poststenotic Flow and Intracranial Hemodynamics in Patients with Carotid Stenosis: Transoral Carotid Ultrasonography Study AJNR Am. J. Neuroradiol., January 1, 2005; 26(1): 76 - 81. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 E. Neri, G. Sani, M. Massetti, G. Frati, D. Buklas, R. Tassi, M. Giubbolini, A. Benvenuti, and C. Sassi Residual dissection of the brachiocephalic arteries: Significance, management, and long-term outcome J. Thorac. Cardiovasc. Surg., August 1, 2004; 128(2): 303 - 312. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. N. Gundamraj and K. K. Lauer Diagnosis of Intracranial Arterial Stenosis Using Transcranial Doppler Flowmetry Anesth. Analg., June 1, 2004; 98(6): 1776 - 1778. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. J. de Boorder, J. Hendrikse, and J. van der Grond Phase-Contrast Magnetic Resonance Imaging Measurements of Cerebral Autoregulation With a Breath-Hold Challenge: A Feasibility Study Stroke, June 1, 2004; 35(6): 1350 - 1354. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. A. Sloan, A. V. Alexandrov, C. H. Tegeler, M. P. Spencer, L. R. Caplan, E. Feldmann, L. R. Wechsler, D. W. Newell, C. R. Gomez, V. L. Babikian, et al. Assessment: Transcranial Doppler ultrasonography: Report of the Therapeutics and Technology Assessment Subcommittee of the American Academy of Neurology Neurology, May 11, 2004; 62(9): 1468 - 1481. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 P. M. Rossini, C. Altamura, A. Ferretti, F. Vernieri, F. Zappasodi, M. Caulo, V. Pizzella, C. Del Gratta, G.-L. Romani, and F. Tecchio Does cerebrovascular disease affect the coupling between neuronal activity and local haemodynamics? Brain, January 1, 2004; 127(1): 99 - 110. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Vernieri, F. Tibuzzi, P. Pasqualetti, N. Rosato, F. Passarelli, P. M. Rossini, and M. Silvestrini Transcranial Doppler and Near-Infrared Spectroscopy Can Evaluate the Hemodynamic Effect of Carotid Artery Occlusion Stroke, January 1, 2004; 35(1): 64 - 70. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
P.M. Rothwell, S.C. Howard, and J.D. Spence Relationship Between Blood Pressure and Stroke Risk in Patients With Symptomatic Carotid Occlusive Disease Stroke, November 1, 2003; 34(11): 2583 - 2590. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P Derdeyn Cerebral Hemodynamics in Carotid Occlusive Disease AJNR Am. J. Neuroradiol., September 1, 2003; 24(8): 1497 - 1499. [Full Text] [PDF]
|
|
|
|
|
|
R. S. Marshall, T. Rundek, D. M. Sproule, B.-F. M. Fitzsimmons, S. Schwartz, and R. M. Lazar Monitoring of Cerebral Vasodilatory Capacity With Transcranial Doppler Carbon Dioxide Inhalation in Patients With Severe Carotid Artery Disease Stroke, April 1, 2003; 34(4): 945 - 949. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. Derdeyn, R. L. Grubb Jr, and W. J. Powers Re: Stages and Thresholds of Hemodynamic Failure Stroke, March 1, 2003; 34(3): 589 - 589. [Full Text] [PDF]
|
|
|
|
|
|
D.R. Rutgers, M.J.P. van Osch, L.J. Kappelle, W.P.T.M. Mali, and J. van der Grond Cerebral Hemodynamics and Metabolism in Patients With Symptomatic Occlusion of the Internal Carotid Artery Stroke, March 1, 2003; 34(3): 648 - 652. [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]
|
|
|
|
|
|
A. Bozzao, R. Floris, F. Gaudiello, V. Finocchi, L. M. Fantozzi, and G. Simonetti Hemodynamic Modifications in Patients with Symptomatic Unilateral Stenosis of the Internal Carotid Artery: Evaluation with MR Imaging Perfusion Sequences AJNR Am. J. Neuroradiol., September 1, 2002; 23(8): 1342 - 1345. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. Ogasawara, A. Ogawa, and T. Yoshimoto Cerebrovascular Reactivity to Acetazolamide and Outcome in Patients With Symptomatic Internal Carotid or Middle Cerebral Artery Occlusion: A Xenon-133 Single-Photon Emission Computed Tomography Study Stroke, July 1, 2002; 33(7): 1857 - 1862. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. Blaser, K. Hofmann, T. Buerger, O. Effenberger, C.-W. Wallesch, and M. Goertler Risk of Stroke, Transient Ischemic Attack, and Vessel Occlusion Before Endarterectomy in Patients With Symptomatic Severe Carotid Stenosis Stroke, April 1, 2002; 33(4): 1057 - 1062. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
K. M. Barrett, R. H. Ackerman, G. Gahn, J. M. Romero, and M. Candia Basilar and Middle Cerebral Artery Reserve: A Comparative Study Using Transcranial Doppler and Breath-Holding Techniques Stroke, December 1, 2001; 32(12): 2793 - 2796. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. Kuroda, K. Houkin, H. Kamiyama, K. Mitsumori, Y. Iwasaki, H. Abe, H. Yonas, L. R. Wechsler, E. Nemoto, and R. Pindzola Long-Term Prognosis of Medically Treated Patients With Internal Carotid or Middle Cerebral Artery Occlusion: Can Acetazolamide Test Predict It? Editorial Comment: Can Acetazolamide Test Predict It? Stroke, September 1, 2001; 32(9): 2110 - 2116. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. R. Pindzola, J. R. Balzer, E. M. Nemoto, S. Goldstein, and H. Yonas Cerebrovascular Reserve in Patients With Carotid Occlusive Disease Assessed by Stable Xenon-Enhanced CT Cerebral Blood Flow and Transcranial Doppler Stroke, August 1, 2001; 32(8): 1811 - 1817. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
F. Vernieri, P. Pasqualetti, M. Matteis, F. Passarelli, E. Troisi, P. M. Rossini, C. Caltagirone, and M. Silvestrini Effect of Collateral Blood Flow and Cerebral Vasomotor Reactivity on the Outcome of Carotid Artery Occlusion Stroke, July 1, 2001; 32(7): 1552 - 1558. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Apruzzese, M. Silvestrini, R. Floris, F. Vernieri, A. Bozzao, G. Hagberg, C. Caltagirone, S. Masala, and G. Simonetti Cerebral Hemodynamics in Asymptomatic Patients with Internal Carotid Artery Occlusion: A Dynamic Susceptibility Contrast MR and Transcranial Doppler Study AJNR Am. J. Neuroradiol., June 1, 2001; 22(6): 1062 - 1067. [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]
|
|
|
|
|
|
H. Markus and M. Cullinane Severely impaired cerebrovascular reactivity predicts stroke and TIA risk in patients with carotid artery stenosis and occlusion Brain, March 1, 2001; 124(3): 457 - 467. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. R. Rutgers, C. J. M. Klijn, L. J. Kappelle, B. C. Eikelboom, A. C. van Huffelen, and J. van der Grond Sustained Bilateral Hemodynamic Benefit of Contralateral Carotid Endarterectomy in Patients With Symptomatic Internal Carotid Artery Occlusion Stroke, March 1, 2001; 32(3): 728 - 734. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
N. Miyazawa, K. Hashizume, M. Uchida, and H. Nukui Long-term Follow-up of Asymptomatic Patients with Major Artery Occlusion: Rate of Symptomatic Change and Evaluation of Cerebral Hemodynamics AJNR Am. J. Neuroradiol., February 1, 2001; 22(2): 243 - 247. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. M. Klijn, L. J. Kappelle, A. C. van Huffelen, G. H. Visser, A. Algra, C. A. F. Tulleken, and J. van Gijn Recurrent ischemia in symptomatic carotid occlusion: Prognostic value of hemodynamic factors Neurology, December 26, 2000; 55(12): 1806 - 1812. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. J. M. Klijn, L. J. Kappelle, J. van der Grond, A. Algra, C. A. F. Tulleken, and J. van Gijn Magnetic Resonance Techniques for the Identification of Patients With Symptomatic Carotid Artery Occlusion at High Risk of Cerebral Ischemic Events Stroke, December 1, 2000; 31(12): 3001 - 3007. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Tegos, M. Sohail, M. M. Sabetai, P. Robless, N. Akbar, G. Pare, G. Stansby, and A. N. Nicolaides Echomorphologic and Histopathologic Characteristics of Unstable Carotid Plaques AJNR Am. J. Neuroradiol., November 1, 2000; 21(10): 1937 - 1944. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
T. J. Tegos, E. Kalodiki, S.-S. Daskalopoulou, and A. N. Nicolaides Stroke: Epidemiology, Clinical Picture, and Risk Factors: Part I of III Angiology, October 1, 2000; 51(10): 793 - 808. [Abstract] [PDF]
|
|
|
|
|
|
D. R. Rutgers, C. J. M. Klijn, L. J. Kappelle, A. C. van Huffelen, and J. van der Grond A Longitudinal Study of Collateral Flow Patterns in the Circle of Willis and the Ophthalmic Artery in Patients With a Symptomatic Internal Carotid Artery Occlusion Stroke, August 1, 2000; 31(8): 1913 - 1920. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 M. Silvestrini, F. Vernieri, P. Pasqualetti, M. Matteis, F. Passarelli, E. Troisi, and C. Caltagirone Impaired Cerebral Vasoreactivity and Risk of Stroke in Patients With Asymptomatic Carotid Artery Stenosis JAMA, April 26, 2000; 283(16): 2122 - 2127. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
S. R. Lash and C. P. Derdeyn Cerebral hemodynamic impairment: Methods of measurement in association with stroke Neurology, March 14, 2000; 54(5): 1210 - 1210. [Full Text] [PDF]
|
|
|
|
|
|
P. M. Rothwell and C. P. Warlow Low Risk of Ischemic Stroke in Patients With Reduced Internal Carotid Artery Lumen Diameter Distal to Severe Symptomatic Carotid Stenosis : Cerebral Protection Due to Low Poststenotic Flow? Stroke, March 1, 2000; 31(3): 622 - 630. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
W. J. Powers, C. P. Derdeyn, S. M. Fritsch, D. A. Carpenter, K. D. Yundt, T. O. Videen, and R. L. Grubb Jr. Benign prognosis of never-symptomatic carotid occlusion Neurology, February 22, 2000; 54(4): 878 - 882. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
R. T.F. Cheung, M. Silvestrini, F. Vernieri, and P. Pasqualetti Cerebrovascular Reactivity in Internal Carotid Artery Occlusion • Response Stroke, December 1, 1999; 30 (12): 2759 - 2768. [Full Text] [PDF]
|
|
|
|
|
|
C. Molina, J. A. Sabin, J. Montaner, A. Rovira, S. Abilleira, and A. Codina Impaired Cerebrovascular Reactivity as a Risk Marker for First-Ever Lacunar Infarction : A Case-Control Study Stroke, November 1, 1999; 30 (11): 2296 - 2301. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
C. P. Derdeyn, R. L. Grubb Jr., and W. J. Powers Cerebral hemodynamic impairment: Methods of measurement and association with stroke risk Neurology, July 1, 1999; 53(2): 251 - 251. [Abstract] [Full Text] [PDF]
|
|