Document Detail


Evaluating middle cerebral artery collateral blood flow reserve using acetazolamide transcranial Doppler ultrasound in patients with carotid occlusive disease.
MedLine Citation:
PMID:  18291458     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: The objective of this study is to examine the utility of acetazolamide TCD ultrasound in the evaluation of MCA collateral blood flow reserve in patients with carotid occlusive disease. METHODS: Acetazolamide TCD and cerebral angiography were performed for 28 carotid territories in 14 patients with carotid occlusive disease. The percentage change in mean blood flow velocity and PI in the MCA was measured before and after 1 g of acetazolamide was administered. The carotid territories were divided into groups according their angiographic findings: (1) mild/moderate (<70%) vs severe (> or =70%) extracranial carotid artery stenosis, and (2) active collateral blood flow to the MCA territory vs no collateral blood flow to the MCA. RESULTS: After acetazolamide injection, the percentage increase in mean MCA velocity for mild/moderate vs severe carotid artery stenosis was 43% +/- 10% and 19% +/- 6%, respectively, indicating less collateral blood flow reserve in patients with severe stenosis (P = .04). The percentage decrease in the PI for MCA territories with vs without angiographic evidence of collateral blood flow was 4.6% +/- 4% and 16% +/- 3%, respectively (P = .04), indicating an exhausted vascular reserve in patients with evidence of active collateral blood flow on angiography. CONCLUSIONS: A decrease in the PI after acetazolamide administration represents a safe and noninvasive indicator of limited collateral blood flow reserve to the MCA territory ipsilateral to an extracranial carotid stenosis. Further study into the role acetazolamide TCD has in the preoperative evaluation of these patients, including threshold values, is warranted.
Authors:
Stephen M Russell; Henry H Woo; Keith Siller; David Panasci; Peter D Leroux
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Publication Detail:
Type:  Clinical Trial; Journal Article     Date:  2008-03-04
Journal Detail:
Title:  Surgical neurology     Volume:  70     ISSN:  0090-3019     ISO Abbreviation:  Surg Neurol     Publication Date:  2008 Nov 
Date Detail:
Created Date:  2008-10-22     Completed Date:  2008-12-02     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  0367070     Medline TA:  Surg Neurol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  466-70; discussion 470     Citation Subset:  IM    
Affiliation:
Department of Neurosurgery, New York University School of Medicine, New York, NY 10016, USA. russes01@yahoo.com
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MeSH Terms
Descriptor/Qualifier:
Acetazolamide / diagnostic use*
Aged
Aged, 80 and over
Blood Flow Velocity / physiology
Carbonic Anhydrase Inhibitors / diagnostic use*
Carotid Stenosis / physiopathology*,  ultrasonography
Cerebrovascular Circulation / physiology
Collateral Circulation / physiology*
Humans
Middle Aged
Middle Cerebral Artery / physiopathology*,  ultrasonography
Reproducibility of Results
Ultrasonography, Doppler, Transcranial*
Vascular Capacitance / physiology
Chemical
Reg. No./Substance:
0/Carbonic Anhydrase Inhibitors; 59-66-5/Acetazolamide

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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