title: Acetazolamide test in detecting reduced cerebral perfusion reserve and predicting long-term prognosis in patients with internal carotid artery occlusion.
abstract: In a series of 32 patients with internal carotid artery occlusion, regional cerebral blood flow (rCBF) and regional cerebral vasoreactivity (rCVR) were measured by xenon-133 single photon emission computed tomography and the acetazolamide test. We evaluated its usefulness in detecting the reduced cerebral perfusion reserve and predicting long-term prognosis. All Type 1 patients (normal rCBF and rCVR) were medically treated and experienced no recurrent ischemic attack. Cerebral hemodynamics remained unchanged. Type 2, 3, and 4 patients underwent superficial temporal artery-middle cerebral artery double anastomosis, if they consented to surgery. All Type 2 (normal rCBF and reduced rCVR) and Type 3 (reduced rCBF and rCVR) patients, who underwent surgery, showed no further ischemic attacks, as well as long-term normalization of rCVR, although long-term rCBF normalization was obtained in only three of seven Type 3 patients. Cerebral hemodynamics remained unchanged in Type 4 patients after surgery. In follow-up periods, major completed stroke occurred in all 3 Type 2 and Type 3 patients who were medically treated. These results suggest that the acetazolamide test is valuable in assessing the cerebral perfusion reserve and predicting long-term prognosis in patients with internal carotid artery occlusion, although further long-term or randomized studies are needed.
authors.affiliation: Department of Neurosurgery, Hokkaido University School of Medicine, Sapporo, Japan.
authors.forename: S
authors.initials: S
authors.lastname: Kuroda
authors.forename: H
authors.initials: H
authors.lastname: Kamiyama
authors.forename: H
authors.initials: H
authors.lastname: Abe
authors.forename: K
authors.initials: K
authors.lastname: Houkin
authors.forename: M
authors.initials: M
authors.lastname: Isobe
authors.forename: K
authors.initials: K
authors.lastname: Mitsumori
mesh_terms: D000086:Acetazolamide; D000328:Adult; D000368:Aged; D001783:Blood Flow Velocity / Q000502:physiology; D001921:Brain / Q000098:blood supply*; D002343:Carotid Artery, Internal / Q000601:surgery; D016893:Carotid Stenosis / Q000175:diagnosis* / Q000601:surgery; D002548:Cerebral Revascularization; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000175:diagnosis; D011379:Prognosis; D012039:Regional Blood Flow / Q000502:physiology; D015899:Tomography, Emission-Computed, Single-Photon; D014057:Tomography, X-Ray Computed; D014980:Xenon Radioisotopes
chemical_list: D014980:Xenon Radioisotopes; D000086:Acetazolamide