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.Th.M. Search for Related Content PubMed PubMed Citation Articles by van der Grond, J. Articles by Mali, W.P.Th.M.

(Stroke. 1996;27:2026-2032.)
© 1996 American Heart Association, Inc.

Articles

Flow-Related Anaerobic Metabolic Changes in Patients With Severe Stenosis of the Internal Carotid Artery

J. van der Grond, PhD; B.C. Eikelboom, MD, PhD W.P.Th.M. Mali, MD, PhD

the Departments of Radiology (J. van der G., W.P.Th.M.M.) and Vascular Surgery (B.C.E.), University Hospital Utrecht (Netherlands).

Correspondence to Dr J. van der Grond, Department of Radiology, University Hospital Utrecht, Heidelberglaan 100, 3584 CX Utrecht, Netherlands. E-mail j.vandergrond@rrn.azu.nl.

Background and Purpose We sought to investigate whether the combination of blood flow measurements in the major cerebral arteries and measurements of cerebral metabolism can provide new insight into the hemodynamic effect of carotid lesions in patients with severe stenosis (>70% reduction in diameter) of the internal carotid artery (ICA).

Methods Fifty-six patients with unilateral severe stenosis of the ICA and 14 control subjects underwent MR imaging, ¹H MR spectroscopy, and MR angiography. Anaerobic metabolic changes were studied by assessing N-acetyl aspartate/choline and lactate/N-acetyl aspartate ratios in the symptomatic and asymptomatic hemispheres. Quantitative flow was measured in the common carotid arteries (CCAs), the ICAs, the basilar artery, and the middle cerebral arteries (MCAs).

Results Blood flow was significantly decreased in the CCA, ICA, and MCA on the ipsilateral side compared with the contralateral side. Flow in the basilar artery was increased, whereas flow in the contralateral MCA was decreased compared with control subjects. We found a significant correlation between anaerobic metabolic changes and the reduction in blood flow in the CCA, ICA, and MCA on the ipsilateral side.

Conclusions This study shows that cerebral metabolism is less impaired in patients with relatively high flow in the major cerebral arteries on the ipsilateral side than in patients with relatively low flow on that side. The combination of MR spectroscopy and MR angiography can be of additional value in the understanding of cerebral hemodynamics and metabolism in patients with vascular disorders.

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

This article has been cited by other articles:

				M. Kamouchi, K. Kishikawa, Y. Okada, T. Inoue, S. Ibayashi, and M. Iida Reappraisal of Flow Velocity Ratio in Common Carotid Artery to Predict Hemodynamic Change in Carotid Stenosis AJNR Am. J. Neuroradiol., April 1, 2005; 26(4): 957 - 962. [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]

				F. C. Bakker, C. J.M. Klijn, J. van der Grond, L. J. Kappelle, and A. Jennekens-Schinkel Cognition and quality of life in patients with carotid artery occlusion: A follow-up study Neurology, June 22, 2004; 62(12): 2230 - 2235. [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]

				K J van Everdingen, L J Kappelle, C J M Klijn, W P T M Mali, and J van der Grond Clinical features associated with internal carotid artery occlusion do not correlate with MRA cerebropetal flow measurements J. Neurol. Neurosurg. Psychiatry, March 1, 2001; 70(3): 333 - 339. [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]

				K. J. van Everdingen, C. J. M. Klijn, L. J. Kappelle, W. P. T. M. Mali, and J. van der Grond MRA Flow Quantification in Patients With a Symptomatic Internal Carotid Artery Occlusion Stroke, August 1, 1997; 28(8): 1595 - 1600. [Abstract] [Full Text]