title: Impaired Cerebrovascular Reactivity Predicts Recurrent Symptoms in Patients with Carotid Artery Occlusion: A Hypercapnia BOLD fMRI Study.
abstract: A key factor in predicting recurrent ischemic episodes in patients with carotid artery occlusion is the presence of hemodynamic impairment. There is, however, no consensus on how to best assess this risk in terms of imaging modalities or thresholds used. Here we investigated whether a predefined threshold of hemispheric asymmetry in hypercapnia fMRI predicts recurrent symptoms in patients with carotid artery occlusion.
  
  
  
  We studied 23 patients (2 women) with a mean age of 67.5 ± 9 years. Patients were assessed for recurrent ischemic events until lost to follow-up, study end, death, or recurrent ischemic event. Hypercapnia fMRI was used to assess the cerebrovascular reserve and quantify the percentage signal change in GM in the MCA territory and the hemispheric asymmetry index. Kaplan-Meier survival analysis and log-rank tests were performed to assess differences between patients with normal or abnormal hemispheric indices.
  
  
  
  The median follow-up was 20 months. During this period, 8 patients experienced recurrent events, and 15 did not. The percentage signal change in GM in the MCA territory was significantly decreased in those patients with recurrent events compared with those without (2.39 ± 0.22 versus 2.70 ± 0.42, P = .032). The normal hemispheric index predicted event-free survival during follow-up (median, 20 months) for both the combined outcome (recurrent events and/or death, log-rank, P = .034) and recurrent retinal or ipsilateral ischemic events only (log-rank, P = .012).
  
  
  
  The hemispheric asymmetry index derived from hypercapnia fMRI showed hemodynamic impairment in more than half of the studied patients with carotid occlusion, and those patients showed a higher risk of recurrent ischemic symptoms.
authors.affiliation: From the Sheffield Vascular Institute (S.D.G.), Northern General Hospital, Sheffield, UK Department of Vascular Surgery (S.D.G., N.A., S.T.R.M.), Queens Medical Centre, Nottingham, UK Department of Radiological Sciences (S.D.G., N.A., D.P.A.), Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK. s.goode@sheffield.ac.uk dorothee.auer@nottingham.ac.uk.
authors.forename: S D
authors.initials: SD
authors.lastname: Goode
authors.affiliation: Department of Vascular Surgery (S.D.G., N.A., S.T.R.M.), Queens Medical Centre, Nottingham, UK Department of Radiological Sciences (S.D.G., N.A., D.P.A.), Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK.
authors.forename: N
authors.initials: N
authors.lastname: Altaf
authors.affiliation: Department of Stroke Medicine (S.M.), Nottingham City Hospital, Nottingham, UK.
authors.forename: S
authors.initials: S
authors.lastname: Munshi
authors.affiliation: Department of Vascular Surgery (S.D.G., N.A., S.T.R.M.), Queens Medical Centre, Nottingham, UK.
authors.forename: S T R
authors.initials: ST
authors.lastname: MacSweeney
authors.affiliation: Department of Radiological Sciences (S.D.G., N.A., D.P.A.), Sir Peter Mansfield Imaging Centre, University of Nottingham, Nottingham, UK. s.goode@sheffield.ac.uk dorothee.auer@nottingham.ac.uk.
authors.forename: D P
authors.initials: DP
authors.lastname: Auer
mesh_terms: D000368:Aged; D001921:Brain / Q000098:blood supply* / Q000000981:diagnostic imaging / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging; D016893:Carotid Stenosis / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018572:Disease-Free Survival; D005260:Female; D005500:Follow-Up Studies; D006439:Hemodynamics / Q000502:physiology*; D006801:Humans; D006935:Hypercapnia; D008279:Magnetic Resonance Imaging / Q000379:methods*; D008297:Male; D008875:Middle Aged