title: Intervention versus standard medical treatment in patients with symptomatic occlusion of the internal carotid artery: a randomised oxygen-15 PET study.
abstract: BACKGROUND
  The aim of this randomised pilot study was to investigate the haemodynamic effects measured by oxygen-15 positron emission tomography (PET) of interventional treatment consisting of either endarterectomy or endovascular treatment of stenosed cerebropetal arteries, or tapering of antihypertensive medication in comparison with standard medical treatment alone in patients with symptomatic internal carotid artery (ICA) occlusion.
  
  
  METHODS
  Twenty-three patients with symptomatic ICA occlusion underwent PET scanning at baseline and after 3 months. Twelve patients were randomised to intervention (either endarterectomy or endovascular treatment of stenosed cerebropetal arteries, or tapering of antihypertensive medication) and 11 to standard medical treatment alone. Primary outcome was a change in cerebral blood flow (CBF), cerebral blood volume (CBV) and/or oxygen extraction fraction (OEF) after 3 months measured by PET.
  
  
  RESULTS
  There were no differences in changes in CBF, CBV or OEF between the two groups. Only patients with compromised perfusion at presentation showed a borderline significant increase in CBF of 2.8 mL/min/100 mL (95% confidence interval 0.0 to 5.7) after intervention (n = 7).
  
  
  CONCLUSIONS
  This pilot study shows that in patients with symptomatic ICA occlusion, oxygen-15 PET did not detect differences in improvement of CBF, CBV or OEF between interventional and standard treatment.
authors.affiliation: Department of Neurology and Neurosurgery, Rudolf Magnus Institute of Neuroscience, University Medical Center Utrecht, G03,228, Heidelberglaan 100, Utrecht 3584 CX, The Netherlands. s.persoon@umcutrecht.nl.
authors.forename: Suzanne
authors.initials: S
authors.lastname: Persoon
authors.forename: Bart Nm
authors.initials: BN
authors.lastname: van Berckel
authors.forename: Jochem P
authors.initials: JP
authors.lastname: Bremmer
authors.forename: Ronald
authors.initials: R
authors.lastname: Boellaard
authors.forename: Ale
authors.initials: A
authors.lastname: Algra
authors.forename: Gert Jan
authors.initials: GJ
authors.lastname: de Borst
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Lammertsma
authors.forename: L Jaap
authors.initials: LJ
authors.lastname: Kappelle
authors.forename: Catharina Jm
authors.initials: CJ
authors.lastname: Klijn