(Stroke. 1998;29:2412-2420.)
© 1998 American Heart Association, Inc.
Original Contributions |
Laser-Doppler Scanning of Local Cerebral Blood Flow and Reserve Capacity and Testing of Motor and Memory Functions in a Chronic 2-Vessel Occlusion Model in Rats
From the Neurosurgical Department, Municipal Hospital, Offenbach (P.T.U.), and the Institute of Neurosurgical Pathophysiology, University Hospital, Mainz, Germany.
Correspondence to Oliver Kempski, PhD, MD, Institute for Neurosurgical Pathophysiology, Johannes Gutenberg University Mainz, Langenbeckstrasse 1, 55131 Mainz, Germany. E-mail kempski{at}nc-patho.klinik.uni-mainz.de
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Abstract |
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Background and Purpose—An animal model of incomplete forebrain ischemia resembling human hemodynamic insufficiency was established. The model allows examination of acute and chronic changes of local cerebral blood flow (lCBF) and reserve capacity in correlation with behavioral parameters.
Methods—Anesthetized male Wistar-Kyoto rats underwent bilateral carotid occlusion (BCO). Laser-Doppler scanning of lCBF at baseline conditions and after acetazolamide was done 30 minutes after BCO, motor and memory function tests were administered after 1 and 2 days, and both investigations were repeated after 1, 2, 4, and 6 weeks. A sham-operated and a control group without any vessel manipulation served as controls.
Results—lCBF dropped within 60 minutes after surgery by 62% (P<0.001) in 10 animals surviving BCO (BCOsurvival) and by 69% in 5 rats that died within 9 days (BCOlethal). Acetazolamide increased lCBF to 142.33% in controls, to 136.66% in sham-operated rats (both significant), and to 104.80% in BCOsurvival (not significant), and it decreased flow by 23.1% in BCOlethal rats (P<0.001). Baseline lCBF normalized within 4 weeks. Total motor function scores were significantly reduced from 9 points preoperatively to 5.80±0.65 in BCOlethal and 6.68±0.54 points in BCOsurvival rats 1 day after occlusion. Memory retention function remained impaired after BCO, as did the acetazolamide response, which correlated with motor score and was inversely related to maze exploration time.
Conclusions—This model allows long-term follow-up of cerebral function, lCBF, and reserve capacity in a pathophysiological setting similar to hemodynamic insufficiency in humans.
Key Words: acetazolamide • cerebral blood flow • cerebral ischemia • cerebrovascular circulation • rats
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Introduction |
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The assessment of cerebrovascular reserve capacity has become a frequently used tool in clinical practice.1 2 3 4 5 6 Impaired vasoreactivity has been used as an indicator of an increased stroke risk due to hemodynamic compromise in cases of obliterative arterial disease.7 8 Measurements of cerebral blood flow (CBF) and reserve capacity9 10 revealed a considerable variability of results in healthy individuals and even more in stroke patients. Little is known about the natural history of impaired cerebrovascular reserve capacity after hemodynamic stroke. Experimental results of Coyle and Panzenbeck11 in rats showed an increase of the luminal diameter of basilar carotid anastomoses to 186% 6 weeks after ipsilateral carotid artery ligation but an insufficient recovery of local CBF (lCBF) compared with controls within that period. However, persisting alterations of reserve capacity with permanently diminished or restored basal CBF are well known in humans after cerebrovascular insults. It has been postulated that those individuals should be prone to cerebral ischemia12 in cases of hemodynamic stress situations such as hypotensive episodes.8
The goal of the present study was to establish a rat model of chronic incomplete forebrain ischemia suitable to frequently monitor lCBF and reserve capacity. To achieve this, bilateral carotid artery occlusion (BCO) was induced in rats as a model of hemodynamic insufficiency, and reserve capacity was assessed repeatedly for 6 weeks together with motor and memory functions.
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Materials and Methods |
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferencesIntroduction |
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Twenty-nine male Wistar-Kyoto rats weighing 304 to 445 g (mean, 353±12.09 g) were used (Charles River Wiga Company, Sulzfeld, Germany). The animals were housed in cages with a 12-hour light/dark cycle and a temperature of 22°C. They had unlimited access to food pellets and water except for 1 day before memory retention testing (see below). All procedures were in accordance with institutional and governmental guidelines.
Surgical Preparation
Anesthesia
The rats were anesthetized with chloral hydrate (36
mg/100 g IP) and supplemented as needed. A 20-gauge catheter filled
with heparinized saline (100 U/mL) was inserted into the tail artery
for continuous monitoring of mean arterial blood pressure
and arterial blood sampling. Normothermia (37.4°C) was
maintained by a rectal thermistor probe connected to a
feedback-regulated heating blanket.
Surgery
The sham-operated controls (n=9) and the rats that were to
undergo carotid occlusion (n=15) were placed in supine position on the
heating blanket. Both common carotid arteries (CCAs) were exposed over
a midline incision, and a dissection was made between the
sternocleidomastoid and the sternohyoid muscles parallel to the
trachea. Each CCA was freed from its adventitial sheath and vagus
nerve, which was carefully separated and maintained. In 5 control
animals the carotid arteries were not exposed.
In 15 rats BCO was initiated (BCO group) with a 7-0 monofilament suture (Ethilon) circled around the left and the right arteries and guided outside through 5-cm-long elastic tubing. The snares on both sides were fixed together with the silicone elastomer tubes by clamps. The same preparation was performed in 9 rats of the sham group. Before the animals were turned and the heads were fixed in a stereotaxic frame, the skin was closed with stitches, sparing the tubes with the sutures around the CCA for later carotid artery occlusion.
The epicranium was exposed by a parieto-occipital midline skin incision in all animals. With the use of microsurgical technique, the periosteum was pushed back, and biparietal parasagittal groove-shaped trephinations (1.5x4 mm) were performed with a microdrill (Mikroton, Aesculap) during continuous irrigation with saline to prevent heating of the tissue. Special care was taken not to penetrate the dura mater. Therefore, a thin layer of the tabula interna of the calvarium was spared.
lCBF Measurement
Baseline lCBF
To monitor the cortical microcirculation, a laser-Doppler
(LD) flow probe (needle-shaped, 0.8 mm), mounted on a
micromanipulator and connected to a laser-flow blood perfusion monitor
(Laserflo 403A, Vasamedics), was used.
lCBF data were collected from 25 locations on each side by moving the LD probe in 0.1-mm steps over the brain surface. Care was taken to obtain flow readings only from areas free of large pial vessels. lCBF was expressed in LD units (LDU). Scanned flow data were used to calculate frequency histograms with a width of the flow classes of 5 LDU and a range between 0 and 150 LDU. Observation frequency was mathematically normalized to 100% and plotted. Details of the technique have been published earlier.13
After a stabilization period of 15 minutes, a baseline scan was
performed on both hemispheres. Flow data were saved on-line on a PC.
Each scan took 
7 minutes. Then the left and shortly thereafter the
right CCA were occluded by pulling the sutures tight. During this
procedure the head remained fixed in the stereotaxic frame,
thereby securing the identical position of the scanning points for the
subsequent measurements. In the sham group, sutures were not pulled
tight and were removed at the end of the experiment. Fifteen minutes
after carotid occlusion, a second scan on both hemispheres was
performed. In the control group without exposure of the carotid
arteries, both basal scans were performed without vessel
manipulation.
Determination of Cerebrovascular Reserve Capacity by
Acetazolamide
The cerebrovascular reserve capacity is defined as change of
lCBF after application of the inhibitor of carbonic
anhydrase, acetazolamide, expressed in percentage of
baseline flow.14 According to experimental
studies with LD monitoring of the cortical microcirculation in
cats15 and rats,16 the
vasodilatory effect of acetazolamide begins 4 to 8 minutes
after intravenous or intraperitoneal
application, reaches a maximum after 20 minutes, and lasts 60
minutes.
Thirty minutes after carotid occlusion or exposure, an intraperitoneal injection of 0.1 mg/g body wt acetazolamide (Diamox, Lederle) was applied. Seventeen minutes after the injection, a third bilateral LD scan was initiated in all 3 groups.
After completion of these 3 LD scans, the animal was turned to the supine position, thereby strictly avoiding recirculation in the BCO group. Permanent occlusion of both CCAs by double ligation with 7-0 silk sutures concluded the acute phase of the experiment. Measurements of lCBF and acetazolamide response were repeated with the animals under chloral hydrate anesthesia after 1, 2, 4, and 6 weeks.
Readings from all single scan points of each animal were usually not normally distributed. Therefore, from the 50 scanning points of each animal a median flow was calculated. Median values of all animals were then averaged and presented ±SEM.
Test Battery
The neurological test battery was always performed between 9 and
12 AM. The labyrinth test (memory retention test) was done
first and the motor function tests second.
Memory Retention Test
The rats were tested in a 4-arm wooden maze installed in a
darkened, quiet room. Each roofless arm (650x180x160 mm)
projected from a square central chamber (420x420x400 mm)
with 4 openings (160x160 mm) to the arms. Each arm contained at
its far end a 150x160x180-mm chamber formed by 2 pieces of wood (at
an 80-mm distance) that fit in notches in each of the 2 walls. The
plates overlapped each other, preventing the rats from directly looking
from the inner part of the arm into the outer chamber but permitting
the rats access to the arm of the maze. One of these chambers contained
food pellets and was kept dark by a removable roof, while the other
chambers and the central compartment were highly illuminated by
lighting a 100-W bulb 1 m above it whenever the rat entered to set
an averse stimulus and to establish a passive avoidance reaction. Maze
adaptation of the rat started after 24 hours of food
deprivation 2 days before the initial CBF measurement and
was repeated 1 day thereafter to test memory retention. The rat was
placed in the central chamber of the maze covered by an opaque box.
When the cover was removed, the light source was switched on, and a
stopwatch was started. Whenever the rat exploring the maze entered 1 of
the 3 open chambers in the arms or the central part of the maze, that
compartment was immediately illuminated. The trial ended as soon as the
rat entered the dark compartment and remained there or after 300
seconds of unsuccessful exploration of the maze. Three compartments in
each arm and the central chamber were defined as separate locations
within the maze. Every change of location was counted, and a mean
frequency of movements was computed from 3 trials. Exploration times
from 3 trials were averaged.
Motor Performance Tests
We examined motor performance with an inclined screen
test, a balance beam test, and the prehensile traction test according
to Combs and D'Alecy17 with minor
modifications.
In the inclined screen test, a 300x300-mm board covered with a cork pad was mounted on a pole and pivoted on the rims of a wooden case 700 mm above a thick sponge pad. The trial started after the rat was placed on the horizontal board. By rotation of the pole slowly but continuously to each side, the plane was inclined to a maximum angle of 60 degrees. The rat scored 3 points when spending 21 to 30 seconds on the board, 2 points for 11 to 20 seconds, 1 point for up to 10 seconds, and 0 points when it fell down immediately or within the first 3 seconds.
In the balance beam test, a wooden rod 700 mm long and 25 mm
wide was positioned horizontally 700 mm above the sponge pad. The
rat was placed at the center of the rod. The score was 0 if the rat
lost hold within 3 seconds, 1 if the rat was able to stay on the beam
for up to 10 seconds, 2 if the time on the rod was between 11 and 20
seconds, and 3 for spending 
21 seconds on the beam.
In the prehensile traction test, a nylon rope, 700 mm long with a
diameter of 5 mm, was stretched horizontally between the rims of
the case with the sponge pad on its bottom. The rat was permitted to
grab the rope with its forefoot pads, and the animal was released. The
time the rat remained on the rope was measured. The score was 0 for <2
seconds, 1 for 3 to 4 seconds, 2 for 5 seconds without bringing a
third limb up to the rope, and 3 for 5 seconds bringing 1 or both
hind paws up to the rope.
The total motor score was calculated as the sum of the scores for the screen, balance beam, and prehensile traction tests. The scores of each test were averaged from 3 trials performed in sequence with a few minutes of rest between tests.
The test battery was repeated on days 4 and 5 of the experiment; 1 day
before and 1 day after the lCBF follow-up measurements after 1, 2, and
4 weeks; and 1 day before the final reserve capacity test after 6 weeks
(Table 1
).
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Statistical Analysis
Descriptive statistics, tests for normal distribution, and
correlation analyses were performed with Sigma Stat, and
illustrations were done with Excel (Microsoft). For
nonparametric tests, the Kruskal-Wallis 1-way ANOVA on
ranks or the Friedman repeated-measures ANOVA on ranks and Dunn's
method for multiple comparisons were used. Medians in collectives
lacking a normal distribution are given; means are
presented ±SEM. Differences are considered significant at
P<0.05.
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Results |
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Acute Stage
Basal lCBF and Acetazolamide Response in Control and Sham-Operated Groups
Fourteen rats served as control group, which consisted of 5 rats without exposure of the CCA and 9 rats that had undergone sham operation. The mean baseline lCBF averaged from the medians of 9 sham-operated animals with 450 individual scan points was 48.00±2.23 LDU. The value was 47.00±1.84 LDU in the control group with 150 individual scan points. In these 5 animals without exposure of the CCAs, the mean of the second measurement 30 minutes later was 46.60±2.11 LDU. In the sham-operated group (n=9), the mean of the second measurement was 37.50±1.83 LDU.
After intraperitoneal application of 0.1 mg/g body
wt acetazolamide, the mean lCBF rose significantly to
70.70±1.49 LDU in the group without any vessel preparation and to
61.00±1.33 LDU in the sham-operated group. Therefore, the mean
response of lCBF to acetazolamide challenge was an increase
to 142.33±4.73% in the control group and to 136.66±2.88% in the
sham group (Figure 3). In both groups the increases were statistically
significant.
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Basal lCBF and Acetazolamide Response in BCO
Group
In 15 animals both CCAs were occluded (BCO group). In 3 rats
ischemia was lethal within 12 hours after occlusion, and in 2
ischemia was lethal between days 7 and 9. These 5 rats are
hereafter referred to as the BCOlethal subgroup,
with the survivors referred to as the BCOsurvival
subgroup. All animals in the BCOlethal subgroup
had severely impaired neurological function on the first day after
occlusion (see below). Thirty minutes after occlusion, the median lCBF
in the BCOsurvival subgroup had dropped
significantly (P<0.001) by 62% from 55.50±4.78 to
21.00±1.2 LDU (Figure 2). In the 5 rats with lethal ischemia,
lCBF decreased also significantly (P<0.001) by 69% from
42.5±2.22 to 13.00±1.33 LDU. Figure 1
presents the frequency histograms of lCBF before and 30 minutes
after carotid occlusion. The frequency maximum in the
BCOsurvival subgroup (Figure 1A) shifted after
occlusion from the flow class 36 to 40 LDU to 16 to 20 LDU; in the
BCOlethal subgroup (Figure 1B), the frequency
maximum shifted from 31 to 35 LDU to 6 to 10 LDU. Fifty-six percent of
the lCBF values in the BCOlethal subgroup were
<15 LDU, compared with 0% before occlusion. The corresponding rates
in the BCOsurvival subgroup are 23.28% and 0%,
respectively.
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Acetazolamide application in the BCOsurvival subgroup produced a minimal change of the lCBF mean from 21.00±1.2 to 22.00±1.81 LDU, which is a nonsignificant 4.8% rise. In the BCOlethal subgroup, acetazolamide caused a significant (P<0.001) 23.1% flow decline from 13.00±1.33 to 10.00±1.57 LDU.
Table 2 depicts mean
arterial blood pressure, pH, gases, and glucose from
arterial blood samples of all groups during surgery. There
were no significant differences.
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Chronic Stage
Preparation of the skull grooves for follow-up lCBF measurements
after reopening of the scalp wound required in most cases the removal
of minor amounts of scar tissue on the preserved thin layer of tabula
interna. There never was any leakage of cerebrospinal fluid. In no case
were signs of inflammation visible.
Table 3 shows the mean body
weight of the control animals and the BCO group at the individual
measurement dates. There was a significant weight loss in the sham
group 2 weeks after surgery (P<0.05) and in the BCO group 1
week after surgery (P<0.05). The differences between the
control, sham, and BCO groups did not reach significance at any time.
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Figure 2
depicts the mean baseline lCBF
at 30 minutes and 1, 2, 4, and 6 weeks after surgery of the control
group and the BCOsurvival subgroup. The lCBF
means of the BCO group show a gradual rise but decrease after 4 weeks,
again differing at all measurements significantly (P<0.05)
from the values of the control group. The means of the sham-operated
group were significantly lower than the means of the control group in
baseline scans of the first measurement (day 3 of the experiment) and
the last measurement 6 weeks thereafter.
The percent acetazolamide responses in the 3 groups at the
various follow-up dates are shown in Figure 3. Values of the BCO group were reduced
and significantly differed at 30 minutes and 2 and 4 weeks from both
the control and the sham groups.
Memory and Motor Function Test Battery
The learning effect reduced the labyrinth exploration time (Figure 4A) within the 2-day training phase
before surgery from 98.80±27.12 to 24.00±4.89 seconds in control
rats, from 109.78±24.84 to 50.33±11.95 seconds in the sham group, and
from 99.60±18.07 to 36.00±7.00 seconds in the BCO group. Differences
between these groups were not significant at baseline conditions. The
maze exploration time remained unchanged during the entire follow-up
period in control and sham-operated rats, while it was significantly
prolonged in the BCO group. Differences between controls or
sham-operated animals versus the BCO group were significant 2 days
after carotid occlusion, before the lCBF measurements after 1 and 6
weeks, and after the measurements 1, 2, and 4 weeks after BCO. There
were no significant differences between the control and the sham groups
at any time (Figure 4A). Animals of the BCOlethal
subgroup after occlusion had an initial mean labyrinth time of
116±46.29 seconds, which did not differ significantly from that of the
BCOsurvival subgroup at 108±18.07 seconds.
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BCO rats showed significantly more futile tries in the maze and needed
more time to find their way into the dark compartment than the
sham-operated animals (Figure 4B).
The baseline total motor function score (maximum, 9.00 points) (Figure 5A) reached means of 8.72±0.07 points in
controls, 8.94±0.03 in the sham group, and 8.99±0.001 in the BCO
group. One day after BCO, the motor score dropped to 5.80±0.65 points
in the BCOlethal subgroup and to 6.68±0.54
points in the BCOsurvival subgroup. The score of
the BCOlethal subgroup was significantly
reduced (P=0.008) compared with the baseline score before
occlusion. In the BCOsurvival subgroup, the
scores on day 5 (7.35±0.36 points) and day 11 (7.51±0.39 points) and
the scores after 4 weeks (day 32: 6.99±0.54) were still significantly
(P<0.05) diminished compared with the baseline score before
BCO. During the entire follow-up period, scores never changed
significantly in controls (P>0.999) and sham-operated rats
(P=0.667).
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Rats with reduced acetazolamide response after BCO showed a
trend (r=-0.304) toward longer labyrinth exploration times
than rats with normal or near normal acetazolamide
responses (Figure 6B). A positive
correlation (r=0.63; P<0.001) was found
between the acetazolamide reactivity and prehensile
traction test scores after the lCBF and reserve capacity measurements
(Figure 7): rats with normal
acetazolamide response could hold onto the rope longer than
rats with a reduced response.
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When the results of the 3 motor test scores are compared, the prehensile traction test reached the highest sensitivity, while most of the rats managed to complete the beam test. The time profile of the score distribution was similar in the prehensile traction test and the screen test, with minimum values on days 4 and 32. It is interesting to note that there were significant deteriorations of the prehensile traction scores at days 11, 18, and 32, ie, secondary to the lCBF measurements and acetazolamide tests performed with the animals under chloral hydrate anesthesia on days 10, 17, and 31.
There was no correlation between the maze exploration time and the scores of the prehensile traction test.
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Discussion |
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferencesIntroduction |
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The 2-vessel occlusion model, proposed by Eklöf and Siesjö18 in 1972 and modified by Smith et al19 in 1984 without the induction of systemic hypotension, has been described as not leading to critical reductions of cortical CBF and not compromising the brain energy state20 without induction of systemic hypotension. Therefore, the model seemed suitable for chronic survival studies, offering a low experimental failure rate from acute death of the animal. In modification of the original concept, we chose a permanent occlusion of the CCAs to create a chronic hemodynamic insufficiency comparable to human pathology and to investigate the spontaneous course of baseline CBF and perfusion reserve.
To compensate for the high variability of single LD flow readings found in cerebral cortex21 and the absence of a calibration of LD flow data to absolute units, LD scanning was introduced.13 22 23 The analysis of flow observation frequency histograms allows discrimination of the different effects of acetazolamide on microcirculation and on larger cortical vessels. A detailed correlation of anatomic structures and lCBF findings (S. Kroppenstedt, MD, unpublished data, 1997) shows that the most pronounced flow increase occurs in regions with a flow <60 LDU (microcirculation), while the flow in the vicinity of larger vessels remains largely unaffected. The flow histograms reveal that flow readings possibly influenced by large pial vessels (>90 LDU) were obtained from <15% of all locations. A distinct evaluation of flow from locations with baseline lCBF values <60 LDU, ie, from the microcirculation (S. Kroppenstedt, MD, unpublished data, 1997), yielded a reduction of flow in acute ischemia from a median 38 to 20 LDU, ie, a 47.4% reduction, which is somewhat less pronounced than the 62% seen if all lCBF values are considered. Interestingly the occlusion of carotid arteries appears to rather homogeneously reduce LD flow, since median flow at all measured locations was 21 LDU. Acetazolamide increased flow from 20 to 21 LDU in the <60 LDU subgroup, which is a 5% increase comparable to the 4.8% in the total population. During the later course of the experiment, changes observed are comparable to those seen in the total population. A similar analysis during the chronic stage is hampered by the fact that locations of measurement cannot be identified again after the animal has been removed from the stereotaxic frame.
Analysis of the lCBF data of the sham group reveals a higher variability than expected. The lCBF means after preparation of CCAs were significantly (P<0.05) lower than those of the control rats, which had no manipulation of the vessels. Nevertheless, the acetazolamide response in this phase was not impaired compared with the control group. As a possible cause of the lowered and unstable perfusion in the sham group, the mechanical irritation of sympathetic nerves on the vessel walls must be considered. An impairment of the neurogenic component of cerebral autoregulation24 25 may contribute to a transient perfusion deficit. The lCBF measurement 1 week after the vessel manipulation yielded a complete recovery. To detect such effects, the control group without any manipulation of neck or intracranial vessels was useful. Six weeks after surgery, baseline lCBF in all groups declined. This phenomenon might be due to the thickening of the remaining bony layer by healing processes. To avoid leakage of cerebrospinal fluid, we did not drill down to the dura after removal of some superficial scar tissue. Adaptation of the animals to the procedures and decreasing stress while anesthesia doses remained constant may also have contributed to the decline of lCBF values.
BCO led to an immediate drop of cortical perfusion in both hemispheres by 62% (by 69% in the rats that did not survive). Eklöf and Siesjö,18 using a similar model, estimated a perfusion decrease of 50% calculated from the cerebral arteriovenous oxygen difference. They observed an inhomogeneous flow distribution but no influence on the energy state of the brain unless the flow reduction exceeded 45% of normal values. Choki et al26 describe in their model of permanent BCO in Wistar rats a reduction of flow between 38% and 9%, depending on the brain structure measured. Similar to our model, Tsuchiya et al27 reported a mortality of 21% in their spontaneously breathing Wistar rats after BCO and a reduction of cortical CBF to 25% to 39%. Lower PO2 and no tendency to hyperventilation in our Wistar-Kyoto rats may be due to the deep anesthesia that we had to maintain to avoid head movements in the stereotaxic frame and dislocations of the LD flow probe.
Because a calibration of LD flowmetry data with absolute perfusion values (milliliters per 100 g per minute) is not possible, data expressed in LD units should be interpreted with caution. A detailed analysis, however, has shown that the biological zero in our system is very low, ie, 0 to 2 LDU, and that repeated measurements in many control cases yield similar median lCBF readings, which represent regional CBF.13 23 Therefore, it may be concluded that BCO may well produce critical flow levels that can be detected by LD. When the 23% mortality rate in the BCO group is considered, median cortical flow values <20 LDU are likely to be in a critical range.
Even more pronounced than the depression of baseline flow values is the reduction of the acetazolamide response in the BCO group still seen 4 and 6 weeks after BCO. The acetazolamide response was severely diminished initially in the BCOsurvival animals and was inverse in the animals with lethal ischemia. Only in the early postocclusion phase did a temporary improvement of the acetazolamide reaction occur in BCOsurvival animals. This phenomenon may be partly explained by a more homogeneous perfusion of the available capillary bed, sufficient for a temporary compensation of an acute state of incomplete ischemia and a transient recovery of the reserve capacity. This has been described as the mechanism of flow increase in hypercapnia by Goebel and coworkers,28 since a recruitment of nonperfused capillaries could be excluded. An exhaustion of this reserve can be suspected because the acetazolamide response was again markedly reduced after 2 weeks. Studies of Coyle and Panzenbeck11 show that basilar carotid anastomoses widen within 6 weeks after unilateral permanent CCA occlusion and a temporary ligation of the contralateral CCA.
Possible negative effects of acetazolamide on ischemic tissue must be considered. The substance that inhibits the enzyme carbonic anhydrase causes hypercapnia and decreases the pH of nonischemic areas, leading to vasodilatation, increases of intracranial pressure, and decreases of CBF in ischemic regions.29 This steal phenomenon supposedly occurs more often in the first minutes after acetazolamide application.30 Acetazolamide may also disturb O2 delivery to the tissue by blocking the Bohr effect. These effects may contribute to the observed worsening of the prehensile traction test and, in the BCO group, after acetazolamide application during the follow-up period.
Memory functions (determined by the labyrinth test) and total motor
score were most severely impaired 1 day after carotid occlusion. For 1
week there was a clear recovery trend of both parameters
(Figures 4 and 5). This development, first described by Combs and
D'Alecy,17 was interpreted by these authors as a
reemergence of functionally depressed neurons. Nevertheless, both
functions appear significantly impaired during the complete follow-up,
even though the motor scores tend to deteriorate after the CBF and
acetazolamide tests. The decline in maze
performance is accompanied by more location changes in the maze
in futile attempts to find the dark compartment. This proves that
prolonged labyrinth exploration times are not due to motor or
psychomotor deficits but rather originate from impaired memory
retention function. Observation of rats in the maze shows that their
behavior exhibits anxious excitement. In addition, the lack of a
correlation between labyrinth times and motor scores makes a direct
influence of motor deficits on the maze exploration behavior unlikely.
However, as a result of the wide scattering of the labyrinth
exploration times in chronic forebrain ischemia, they correlate
at most loosely with the acetazolamide responses.
Prehensile traction test proved to be the most sensitive motor test,
which correlated best with reserve capacity (Figure 7).
Imamura et al31 describe a partial recovery of learning and working memory of gerbils 4 weeks after a 5-minute BCO. In our experiment the possible negative effects of acetazolamide application on functional test scores have to be considered since significant deteriorations, particularly of forelimb grasping strength, were observed after anesthesia for lCBF measurement and acetazolamide test compared with the scores 1 day before those measurements. Another possible explanation for the late worsening of the functional parameters could be the delayed progress of neuronal damage.32
A negative correlation between the lCBF response to acetazolamide and the labyrinth time, which shortens with intact memory retention function, and a positive correlation between the acetazolamide response and the motor score could be expected from theoretical considerations and clinical experience.12 However, our results could only confirm a loose correlation between hemodynamic responses and the data of the memory retention test. Nevertheless, the severity of ischemic motor deficits seemed to be predictable by reserve capacity testing. This offers perspectives for further investigations on the impact of reduced reserve capacity on brain function and histopathology with this easily performed and inexpensive 2-vessel occlusion rat model, which reproduces the clinical presentation of chronic hemodynamic insufficiency.
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Acknowledgments |
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This article contains substantial elements of the doctoral thesis of one of the authors (Dr Kroppenstedt). The authors wish to thank Andrea Schollmayer and Mitch Malzahn for their excellent technical support and Monika Westenhuber for secretarial assistance.
Received January 7, 1998; revision received June 2, 1998; accepted July 28, 1998.
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferencesIntroduction |
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Editorial Comment
Department of Neurological Surgery University of California, Davis Davis, California
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Introduction |
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TopAbstractIntroductionMaterials and MethodsResultsDiscussionReferencesIntroduction |
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Ulrich and colleagues have provided an interesting characterization of incomplete cerebral ischemia as an animal model of chronic cerebral hemodynamic insufficiency. Within the limitations and restrictions of the LD technique, they have provided evidence of continued reduction of cerebral circulation lasting
6 weeks after initiation of BCO. The use of the hypercapnia
challenge with systemic administration of acetazolamide
provides a functional indicator of the chronic vascular impairment in
this model. The authors also included behavioral outcome measures.
However, the vascular insult had no effect on 2 of the 3 motor tasks
and produced only modest deleterious effects on the prehensile traction
test. In contrast, the more complex behavior demands of the labyrinth
test demonstrated more robust and reliable behavioral consequences of
BCO. The lack of convincing data for the acetazolamide
challenge to predict memory performance may provide a clue as
to the nature of this behavioral deficit. The data suggest that the
complex behavior deficits may be more a function of
ischemia-related tissue damage rather than a function of the
ability of the vasculature to respond normally to the demands of a
hypercapnic challenge. One might further explore the contribution of
impaired reserve capacity to behavioral performance deficits by
testing control and BCO rats while perturbed by the
acetazolamide challenge. Received January 7, 1998; revision received June 2, 1998; accepted July 28, 1998.
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