title: Quantitative volumetry in patients with carotid disease--effects of acetazolamide.
abstract: The intracranial effects of acetazolamide on flow velocities can be monitored noninvasively by transcranial Doppler (TCD) sonography. Extracranial volume flow changes can now reliably be measured with color duplex M-mode systems. The authors tested the volumetric effects of acetazolamide in patients with high-grade unilateral carotid disease to quantify the amount of flow changes. Patients in group 1 had a high-grade > 70% internal carotid artery (ICA) stenosis, without collateral flow through the ophthalmic artery (OA). Patients with occluded ICA were included in group 2 (patent OA collateralization) or group 3 (no OA collateralization) (n = 6 per group). In group 1, common carotid artery (CCA) volume flow in the stenotic (normal contralateral) side increased from 271 (388) ml/min by 52 (54%) with 1 g aceta-zolamide intravenously. Simultaneously, middle cerebral artery (MCA) flow velocities increased from 54 (56) cm/s by 47 (53%). In group 2, extracranial volume flow increased from 166 (444) ml/min by 19 (52)%. MCA flow velocities increased from 43 (65) cm/s by 13 (30)%. In group 3, volume flow increased from 159 (467) ml/min by 2 (46)%. Intracranial flow velocities rose from 49 (54) cm/s by 27 (41)%. Volume flow data showed the expected decline in patients with high-grade ICA stenosis and even more pronounced in patients with occlusion of the vessel. Cerebral reserve capacity was less sufficient in patients with a patent OA, despite an additional supply of 30 ml/min, indicating a hemodynamically critical situation.
authors.affiliation: Department of Clinical Neurophysiology, University of Göttingen, Germany. eicke@neurologie.klinik.uni-mainz.de
authors.forename: B M
authors.initials: BM
authors.lastname: Eicke
authors.forename: R R
authors.initials: RR
authors.lastname: Bähr
authors.forename: E
authors.initials: E
authors.lastname: Buss
authors.forename: C
authors.initials: C
authors.lastname: Doberenz
authors.forename: W
authors.initials: W
authors.lastname: Paulus
mesh_terms: D000086:Acetazolamide / Q000494:pharmacology*; D000368:Aged; D001783:Blood Flow Velocity / Q000187:drug effects; D001810:Blood Volume / Q000187:drug effects; D002257:Carbonic Anhydrase Inhibitors / Q000494:pharmacology; D017536:Carotid Artery, Common / Q000000981:diagnostic imaging / Q000503:physiopathology; D002343:Carotid Artery, Internal; D016893:Carotid Stenosis / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D002560:Cerebrovascular Circulation / Q000187:drug effects*; D003097:Collateral Circulation; D006801:Humans; D008875:Middle Aged; D020768:Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D009880:Ophthalmic Artery / Q000000981:diagnostic imaging / Q000503:physiopathology; D017585:Ultrasonography, Doppler, Transcranial; D014665:Vasodilator Agents / Q000494:pharmacology*
chemical_list: D002257:Carbonic Anhydrase Inhibitors; D014665:Vasodilator Agents; D000086:Acetazolamide