This Article Full Text 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 van der Grond, J. Articles by Mali, W.P.T.M. Search for Related Content PubMed PubMed Citation Articles by van der Grond, J. Articles by Mali, W.P.T.M.

(Stroke. 1995;26:822-828.)
© 1995 American Heart Association, Inc.

Articles

Cerebral Metabolism of Patients With Stenosis or Occlusion of the Internal Carotid Artery

A ¹H-MR Spectroscopic Imaging Study

J. van der Grond, PhD; R. Balm, MD; L.J. Kappelle, MD, PhD; B.C. Eikelboom, MD, PhD W.P.T.M. Mali, MD, PhD

From the Departments of Radiology (J. van der G., W.P.T.M.M.), Vascular Surgery (R.B., B.C.E.), and Neurology (L.J.K.), University Hospital Utrecht, Netherlands.

Correspondence to Dr J. van der Grond, Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands.

Background and Purpose Occlusion or severe stenosis of extracranial vessels may lead to hypoperfusion without overt infarction of brain tissue. The aim of this study was to investigate whether occlusion of the internal carotid artery or stenosis with reduction in diameter of more than 70% leads to altered cerebral metabolism in regions in which no infarcts are visible with magnetic resonance imaging.

Methods We studied 10 control subjects and 55 patients with transient or nondisabling cerebral ischemia (25 patients with severe unilateral stenosis, 15 patients with unilateral occlusion, and 15 patients with bilateral severe stenosis or occlusion of the internal carotid artery). All subjects underwent magnetic resonance imaging and ¹H magnetic resonance spectroscopic imaging. Cerebral metabolism was studied by assessing ratios of N-acetyl aspartate (NAA) to choline and to creatine as well as lactate from noninfarcted frontal, mesial, and parietal regions in the centrum semiovale in both hemispheres.

Results All patients with unilateral stenosis or occlusion of the internal carotid artery had decreased NAA/choline ratios in noninfarcted areas in the hemisphere on the side of the stenosis or occlusion and normal NAA/choline ratios in the contralateral hemisphere. Patients with bilateral stenosis or occlusion had decreased NAA/choline ratios in both hemispheres. In one third of all patients, cerebral lactate was found in regions without abnormalities on magnetic resonance imaging.

Conclusions A severe reduction in the diameter of the internal carotid artery affects cerebral metabolism in regions that are not infarcted. These changes are reflected in a decreased NAA/choline ratio and a high incidence of cerebral lactate. These regions are probably at risk for infarction in the long term or if cerebral perfusion decreases further.

Key Words: carotid arteries • cerebral blood flow • cerebral ischemia • magnetic resonance imaging

This article has been cited by other articles:

				M Paciaroni, V Caso, M Acciarresi, R W Baumgartner, and G Agnelli Management of asymptomatic carotid stenosis in patients undergoing general and vascular surgical procedures J. Neurol. Neurosurg. Psychiatry, October 1, 2005; 76(10): 1332 - 1336. [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]

				M Kamba, Y Inoue, S Higami, Y Suto, T Ogawa, and W Chen Cerebral metabolic impairment in patients with obstructive sleep apnoea: an independent association of obstructive sleep apnoea with white matter change J. Neurol. Neurosurg. Psychiatry, September 1, 2001; 71(3): 334 - 339. [Abstract] [Full Text] [PDF]

				D Lythgoe, A Simmons, A Pereira, M Cullinane, S Williams, and H S Markus Magnetic resonance markers of ischaemia: their correlation with vasodilatory reserve in patients with carotid artery stenosis and occlusion J. Neurol. Neurosurg. Psychiatry, July 1, 2001; 71(1): 58 - 62. [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]

				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]

				C. J. M. Klijn, L. J. Kappelle, C. A. F. Tulleken, and J. van Gijn Symptomatic Carotid Artery Occlusion : A Reappraisal of Hemodynamic Factors Stroke, October 1, 1997; 28(10): 2084 - 2093. [Abstract] [Full Text]

				M. KAMBA, Y. SUTO, Y. OHTA, Y. INOUE, and E. MATSUDA Cerebral Metabolism in Sleep Apnea . Evaluation by Magnetic Resonance Spectroscopy Am. J. Respir. Crit. Care Med., July 1, 1997; 156(1): 296 - 298. [Abstract] [Full Text]

				J. van der Grond, B.C. Eikelboom, and W.P.Th.M. Mali Flow-Related Anaerobic Metabolic Changes in Patients With Severe Stenosis of the Internal Carotid Artery Stroke, November 1, 1996; 27(11): 2026 - 2032. [Abstract] [Full Text]