Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion - A xenon-133 single-photon emission computed tomography study
Cerebrovascular reactivity to acetazolamide and outcome in patients with symptomatic internal carotid or middle cerebral artery occlusion - A xenon-133 single-photon emission computed tomography study
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DOI：
10.1161/01.str.0000019511.81583.a8
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发表时间：
2002-07-01
期刊：
影响因子：
8.3
通讯作者：
Yoshimoto, T
中科院分区：
文献类型：
--
作者：
Ogasawara, K;Ogawa, A;Yoshimoto, T
背景和目的：本研究通过使用氙气(Xe-133)吸入和单光子发射计算机断层扫描(SPECT)定量测量脑血流量，前瞻性地评估了症状性大脑大动脉闭塞患者的基线特征、脑血流动力学和预后之间的关系。方法：在研究开始时，使用Xe-133 SPECT计算局部脑血管反应性(RCVR)。70例年龄<70岁的单侧颈内动脉(ICA)或大脑中动脉(MCA)闭塞患者分为RCVR正常组和RCVR减少组，前瞻性随访24个月。结果：23例入院时RCVR降低的患者中有8例再发卒中，47例RCVR正常的患者中有3例再发卒中。所有患者以及颈内动脉或大脑中动脉闭塞和入院时右脑血管阻力降低的患者的累积无复发生存率均显著低于右心静脉血流正常的患者(分别为P=0.0030、P=0.0404和P=0.0310；Kaplan-Meier分析)。在考虑的因素中，只有较低的RCVR和静息局部脑血流值与卒中复发的风险显著相关(分别为P=0.0019和P=0.0080；COX回归多因素分析)。结论-本研究表明，Xe-133SPECT测定的RCVR减少为乙酰唑胺与有症状的大脑中动脉或颈内动脉闭塞患者卒中复发的风险显著相关。
Background and Purpose-The present study prospectively evaluated relationships among baseline characteristics, cerebral hemodynamics, and outcome of patients with symptomatic major cerebral artery occlusion, by quantitative measurement of cerebral blood flow using xenon-133 (Xe-133) inhalation and single-photon emission computed tomography (SPECT).Methods-Regional cerebrovascular reactivity (rCVR) to acetazolamide was calculated at entry to the study using Xe-133 SPECT. Seventy consecutive patients aged less than 70 years with unilateral internal carotid artery (ICA) or middle cerebral artery (MCA) occlusion were divided into 2 groups: normal or reduced rCVR, and prospectively followed up for a period of 24 months.Results-During the follow-up period, recurrent strokes occurred in 8 of the 23 patients with reduced rCVR at entry and in 3 of 47 patients with normal rCVR. Cumulative recurrence-free survival rates in all patients, and in each subgroup of patients with ICA or MCA occlusion and reduced rCVR on entry, were significantly lower than in those with normal rCVR (P=0.0030, P=0.0404, and P=0.0310, respectively; Kaplan-Meier analysis). Among the factors considered, only lower rCVR and resting regional cerebral blood flow values were significantly associated with the risk of stroke recurrence (P=0.0019 and P=0.0080, respectively; Cox regression multivariate analysis).Conclusions-The present study demonstrated that reduced rCVR to acetazolamide as determined by Xe-133 SPECT is significantly associated with an increased risk of stroke recurrence in patients with symptomatic MCA or ICA occlusion.