This Article Full Text Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Kuroda, S. Articles by Pindzola, R. Search for Related Content PubMed PubMed Citation Articles by Kuroda, S. Articles by Pindzola, R. Pubmed/NCBI databases Compound via MeSH Substance via MeSH Hazardous Substances DB ACETAZOLAMIDE Medline Plus Health Information Stroke Related Collections By-pass procedures Brain Circulation and Metabolism PET and SPECT Primary and Secondary Stroke Prevention Risk Factors for Stroke

(Stroke. 2001;32:2110.)
© 2001 American Heart Association, Inc.

Original Contributions

Long-Term Prognosis of Medically Treated Patients With Internal Carotid or Middle Cerebral Artery Occlusion

Can Acetazolamide Test Predict It?

Satoshi Kuroda, MD; Kiyohiro Houkin, MD; Hiroyasu Kamiyama, MD; Kenji Mitsumori, MD; Yoshinobu Iwasaki, MD Hiroshi Abe, MD

From the Department of Neurosurgery, Hokkaido University Graduate School of Medicine (S.K., K.H., H.K., Y.K., H.A.), and Hokkaido Neurosurgical Memorial Hospital (K.M.), Sapporo, Japan.

Correspondence to Satoshi Kuroda, MD, Department of Neurosurgery, Hokkaido University Graduate School of Medicine, North 15 West 7, Kita-Ku, Sapporo 060-8638, Japan. E-mail skuroda{at}med.hokudai.ac.jp

Background and Purpose—— The importance of hemodynamic parameters for predicting outcome in patients with occlusive carotid disease remains controversial. The present study was aimed at testing the hypothesis that regional cerebrovascular reactivity (rCVR) to acetazolamide can be a reliable predictor of subsequent ischemic stroke in medically treated patients with internal carotid artery or middle cerebral artery occlusion.

Methods—— Seventy-seven symptomatic patients were enrolled in this prospective, longitudinal cohort study. All patients met inclusion criteria of cerebral angiography, no or localized cerebral infarction on MRI or CT, and no or minimal neurological deficit. Regional cerebral blood flow (rCBF) and rCVR to acetazolamide were quantitatively determined by ¹³³Xe SEPCT. All patients were categorized into 4 types on the basis of SPECT studies.

Results—— During an average follow-up period of 42.7 months, 16 total and 7 ipsilateral ischemic strokes occurred. The annual risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were 35.6% and 23.7%, respectively, risks that are higher than those in other types of patients. When strokes were categorized into patients with and without decreased rCBF and rCVR, Kaplan-Meier analysis revealed that the risks of total and ipsilateral stroke in patients with decreased rCBF and rCVR were significantly higher than in those without (P<0.0001 and P=0.0001, respectively, log-rank test). Relative risk conferred by decreased rCBF and rCVR was 8.0 (95% CI, 1.9 to 34.4) for ipsilateral stroke and 3.6 (95% CI, 1.4 to 9.3) for total stroke.

Conclusions—— Decreased rCBF and rCVR to acetazolamide may identify a subgroup of patients who have a higher risk of subsequent ischemic stroke when treated medically.

Editorial Comment

Can Acetazolamide Test Predict It?

Howard Yonas, MD; Larry R. Wechsler, MD; Edward Nemoto, PhD; Ronda Pindzola, PhD Guest Editors

This article has been cited by other articles:

				M. Nakamura, F. Okamoto, K. Nakanishi, R. Maruyama, A. Yamada, S. Ushikoshi, S. Terasaka, S. Kuroda, K. Sakai, and T. Higami Does Intensive Management of Cerebral Hemodynamics and Atheromatous Aorta Reduce Stroke After Coronary Artery Surgery? Ann. Thorac. Surg., February 1, 2008; 85(2): 513 - 519. [Abstract] [Full Text] [PDF]

				J. J. Alexander, J. Moawad, and D. Super Outcome Analysis of Carotid Artery Occlusion Vascular and Endovascular Surgery, November 1, 2007; 41(5): 409 - 416. [Abstract] [PDF]

				S. Kuroda, N. Hashimoto, T. Yoshimoto, Y. Iwasaki, and for the Research Committee on Moyamoya Disease in Radiological Findings, Clinical Course, and Outcome in Asymptomatic Moyamoya Disease: Results of Multicenter Survey in Japan Stroke, May 1, 2007; 38(5): 1430 - 1435. [Abstract] [Full Text] [PDF]

				I. Uzunca, T. Asil, K. Balci, and U. Utku Evaluation of Vasomotor Reactivity by Transcranial Doppler Sonography in Patients With Acute Stroke Who Have Symptomatic Intracranial and Extracranial Stenosis J. Ultrasound Med., February 1, 2007; 26(2): 179 - 185. [Abstract] [Full Text] [PDF]

				A. Chen, M.-H. Shyr, T.-Y. Chen, H.-Y. Lai, C.-C. Lin, and P.-S. Yen Dynamic CT Perfusion Imaging with Acetazolamide Challenge for Evaluation of Patients with Unilateral Cerebrovascular Steno-Occlusive Disease. AJNR Am. J. Neuroradiol., October 1, 2006; 27(9): 1876 - 1881. [Abstract] [Full Text] [PDF]

				A. F. van Raamt, A. P. A. Appelman, W. P. T. M. Mali, Y. van der Graaf, and For the SMART Study Group Arterial Blood Flow to the Brain in Patients with Vascular Disease: The SMART Study. Radiology, August 1, 2006; 240(2): 515 - 521. [Abstract] [Full Text] [PDF]

				H. Endo, T. Inoue, K. Ogasawara, T. Fukuda, Y. Kanbara, and A. Ogawa Quantitative Assessment of Cerebral Hemodynamics Using Perfusion-Weighted MRI in Patients With Major Cerebral Artery Occlusive Disease: Comparison With Positron Emission Tomography Stroke, February 1, 2006; 37(2): 388 - 392. [Abstract] [Full Text] [PDF]

				S. Kuroda, T. Shiga, K. Houkin, T. Ishikawa, C. Katoh, N. Tamaki, and Y. Iwasaki Cerebral Oxygen Metabolism and Neuronal Integrity in Patients With Impaired Vasoreactivity Attributable to Occlusive Carotid Artery Disease Stroke, February 1, 2006; 37(2): 393 - 398. [Abstract] [Full Text] [PDF]

				S. Kuroda, T. Ishikawa, K. Houkin, R. Nanba, M. Hokari, and Y. Iwasaki Incidence and Clinical Features of Disease Progression in Adult Moyamoya Disease Stroke, October 1, 2005; 36(10): 2148 - 2153. [Abstract] [Full Text] [PDF]

				J. Deguchi, M. Yamada, H. Kobata, and T. Kuroiwa Regional Cerebral Blood Flow After Acetazolamide Challenge in Patients with Dural Arteriovenous Fistula: Simple Way to Evaluate Intracranial Venous Hypertension AJNR Am. J. Neuroradiol., May 1, 2005; 26(5): 1101 - 1106. [Abstract] [Full Text] [PDF]

				P J Kirkpatrick and I Ng Cerebral revascularisation: where are we now? J. Neurol. Neurosurg. Psychiatry, April 1, 2005; 76(4): 463 - 465. [Full Text] [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]

				J-C Baron Using PET to identify carotid occlusion patients at high risk of subsequent stroke: further insights J. Neurol. Neurosurg. Psychiatry, December 1, 2004; 75(12): 1659 - 1660. [Full Text] [PDF]

				S. Kuroda, T. Shiga, T. Ishikawa, K. Houkin, T. Narita, C. Katoh, N. Tamaki, and Y. Iwasaki Reduced Blood Flow and Preserved Vasoreactivity Characterize Oxygen Hypometabolism Due to Incomplete Infarction in Occlusive Carotid Artery Diseases J. Nucl. Med., June 1, 2004; 45(6): 943 - 949. [Abstract] [Full Text] [PDF]

				H.-Y. Lee, J. C. Paeng, D. S. Lee, J. S. Lee, C. W. Oh, M. J. Cho, J.-K. Chung, and M. C. Lee Efficacy Assessment of Cerebral Arterial Bypass Surgery Using Statistical Parametric Mapping and Probabilistic Brain Atlas on Basal/Acetazolamide Brain Perfusion SPECT J. Nucl. Med., February 1, 2004; 45(2): 202 - 206. [Abstract] [Full Text] [PDF]

				H. Yamauchi, H. Okazawa, K. Sugimoto, Y. Kishibe, and M. Takahashi The Effect of Deafferentation on Cerebral Blood Flow Response to Acetazolamide AJNR Am. J. Neuroradiol., January 1, 2004; 25(1): 92 - 96. [Abstract] [Full Text] [PDF]

				H Yamauchi, H Okazawa, Y Kishibe, K Sugimoto, and M Takahashi Oxygen extraction fraction and acetazolamide reactivity in symptomatic carotid artery disease J. Neurol. Neurosurg. Psychiatry, January 1, 2004; 75(1): 33 - 37. [Abstract] [Full Text] [PDF]

				H. Okazawa, H. Yamauchi, K. Sugimoto, and M. Takahashi Differences in Vasodilatory Capacity and Changes in Cerebral Blood Flow Induced by Acetazolamide in Patients with Cerebrovascular Disease J. Nucl. Med., September 1, 2003; 44(9): 1371 - 1378. [Abstract] [Full Text] [PDF]

				K. Ogasawara, T. Okuguchi, M. Sasoh, M. Kobayashi, H. Yukawa, K. Terasaki, T. Inoue, and A. Ogawa Qualitative versus Quantitative Assessment of Cerebrovascular Reactivity to Acetazolamide Using iodine-123-N-Isopropyl-p-Iodoamphetamine SPECT in Patients with Unilateral Major Cerebral Artery Occlusive Disease AJNR Am. J. Neuroradiol., June 1, 2003; 24(6): 1090 - 1095. [Abstract] [Full Text] [PDF]

				K. Ogasawara, H. Ito, M. Sasoh, T. Okuguchi, M. Kobayashi, H. Yukawa, K. Terasaki, and A. Ogawa Quantitative Measurement of Regional Cerebrovascular Reactivity to Acetazolamide Using 123I-N-Isopropyl-p-Iodoamphetamine Autoradiography with SPECT: Validation Study Using H215O with PET J. Nucl. Med., April 1, 2003; 44(4): 520 - 525. [Abstract] [Full Text] [PDF]