title: Progressive Cortical Neuronal Damage and Chronic Hemodynamic Impairment in Atherosclerotic Major Cerebral Artery Disease.
abstract: Cross-sectional studies suggest that chronic hemodynamic impairment may cause selective cortical neuronal damage in patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease. The purpose of this longitudinal study was to determine whether the progression of cortical neuronal damage, evaluated as a decrease in central benzodiazepine receptors (BZRs), is associated with hemodynamic impairment at baseline or hemodynamic deterioration during follow-up.
  
  
  
  We evaluated the distribution of BZRs twice using positron emission tomography and (11)C-flumazenil over time in 80 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease that had no ischemic episodes during follow-up. Using 3D stereotactic surface projections, we quantified abnormal decreases in the BZRs in the cerebral cortex within the middle cerebral artery distribution and correlated changes in the BZR index with the mean hemispheric values of hemodynamic parameters obtained from (15)O gas positron emission tomography.
  
  
  
  In the hemisphere affected by arterial disease, the BZR index in 40 patients (50%) was increased during follow-up (mean 26±20 months). In multivariable logistic regression analyses, increases in the BZR index were associated with the decreased cerebral blood flow at baseline and an increased oxygen extraction fraction during follow-up. Increases in the oxygen extraction fraction during follow-up were associated with a lack of statin use.
  
  
  
  In patients with atherosclerotic internal carotid artery or middle cerebral artery disease, the progression of cortical neuronal damage was associated with hemodynamic impairment at baseline and hemodynamic deterioration during follow-up. Statin use may be beneficial against hemodynamic deterioration and therefore neuroprotective.
authors.affiliation: From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan. yamauchi@res.med.shiga-pref.jp.
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yamauchi
authors.affiliation: From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan.
authors.forename: Shinya
authors.initials: S
authors.lastname: Kagawa
authors.affiliation: From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan.
authors.forename: Yoshihiko
authors.initials: Y
authors.lastname: Kishibe
authors.affiliation: From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Takahashi
authors.affiliation: From the Division of PET Imaging, Shiga Medical Center Research Institute, Moriyama, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Higashi
mesh_terms: D000368:Aged; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000473:pathology; D002539:Cerebral Arterial Diseases / Q000000981:diagnostic imaging / Q000473:pathology*; D002540:Cerebral Cortex / Q000000981:diagnostic imaging / Q000378:metabolism / Q000473:pathology*; D002560:Cerebrovascular Circulation; D003430:Cross-Sectional Studies; D005260:Female; D005442:Flumazenil; D006439:Hemodynamics; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy; D002537:Intracranial Arteriosclerosis / Q000000981:diagnostic imaging / Q000473:pathology*; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009474:Neurons / Q000473:pathology*; D049268:Positron-Emission Tomography; D011379:Prognosis; D019275:Radiopharmaceuticals; D011963:Receptors, GABA-A / Q000187:drug effects / Q000378:metabolism; D012307:Risk Factors
chemical_list: D019275:Radiopharmaceuticals; D011963:Receptors, GABA-A; D005442:Flumazenil
keywords: carotid artery disease; cerebral cortex; positron-emission tomography; prognosis; risk factors