Cerebral vascular reactivity assessed with acetazolamide single photon emission computer tomography scans before and after carotid endarterectomy.
METHODS
In 64 patients, cerebral perfusion and vascular reactivity were assessed before and after carotid endarterectomy (CEA) using acetazolamide (ACZ)-enhanced single photon emission computer tomography (SPECT). Twenty-five patients were asymptomatic, whereas the remainder were symptomatic. Sixty-one patients had a > or = 70% ipsilateral internal carotid artery stenosis.


RESULTS
Fifty SPECT scans revealed decreased vascular reactivity. Twenty-three showed infarcts. Fourteen patients had normal studies. Twenty of the SPECT scans of asymptomatic patients demonstrated poor vascular reactivity. After CEA, 39 patients had improved ipsilateral vasoreactivity. In 12 patients, contralateral improvement was also found.


CONCLUSIONS
ACZ-enhanced SPECT scans, by assessing cerebral perfusion and vascular reactivity, may help to identify patients at risk of stroke should perfusion further diminish. Postoperative studies confirm improvement in vascular reactivity. ACZ-enhanced SPECT scans may provide objective evidence for the selection of patients with a high-grade asymptomatic carotid stenosis for CEA.
Cikrit
D F
DF
Department of Surgery, Richard L. Roudebush Veterans Administration Hospital, Indiana University Medical Center, Indianapolis 46202, USA.
Dalsing
M C
MC
Harting
P S
PS
Burt
R W
RW
Lalka
S G
SG
Sawchuk
A P
AP
Solooki
B
B
D000086:Acetazolamide; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000503:physiopathology* / Q000601:surgery; D002560:Cerebrovascular Circulation; D016894:Endarterectomy, Carotid; D006801:Humans; D019275:Radiopharmaceuticals; D015899:Tomography, Emission-Computed, Single-Photon / Q000379:methods
D019275:Radiopharmaceuticals; D000086:Acetazolamide