Download PDF
CC BY-NC-ND 4.0 · Asian J Neurosurg 2020; 15(03): 566-572
DOI: 10.4103/ajns.AJNS_223_20
Original Article

Fate of patients with chronic cerebrovascular steno-occlusive disease according to change of cerebral perfusion, cerebrovascular reserved, and incidence of recurrent ischemic stroke

Dittapong Songsaeng
Department of Radiology, Division of Diagnostic Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
,
Athaporn Sriyapai
Department of Radiology, Division of Diagnostic Radiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
,
Ittichai Sakarunchai
1   Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Prince of Songkla University, Songkhla
,
Bencharatana Yokubol
2   Department of Anesthesiology, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
,
Sarun Nanta-aree
3   Department of Surgery, Division of Neurosurgery, Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok
,
Nanthasak Tisavipat
4   Neuroscience Center, Bangkok Hospital, Bangkok
› Author Affiliations
› Further Information
Also available at
   Permissions and Reprints

Objective: The objective is to demonstrate change of cerebral perfusion and cerebrovascular reserve (CVR) in treating patients with cerebrovascular steno-occlusive disease stratified by change of cerebral perfusion and CVR. Methods: Retrospective review patients with radiographic proven major cerebrovascular steno-occlusive disease whom underwent cerebral perfusion imaging with vasoactive stimuli stress test in Siriraj Hospital and Bangkok General Hospital during 2010–2018. Medical records were also reviewed. Radiographic findings, cerebral perfusion parameters and signal change during the stress test were reviewed and used to categorize into three groups. Results: There were 40 patients sent to radiology department for the evaluation of CVR. One patient had airway problem during the procedure and was excluded. Remaining 39 patients were included in this study (32 males and 7 females, mean age of 54.55 years). In 42 sites involved, 28 (66%) were internal carotid artery, 14 (33%) were middle cerebral arteries. Laterality is left side in 20 cases, right side in 14 cases, and bilateral in 5 cases. Poor CVR response (increased cerebral blood flow <10%) was found in 9 patients (2 severe stenoses and 7 total occlusions). The mean follow-up time was 28.9 months. Eight cases (20.5%) underwent surgical treatment; surgical bypasses and endovascular interventions. Only one patient had subsequential ischemic symptom at immediate postoperative vascular bypass surgery. The remaining patients had no report of progressive or recurrent neurological deficit symptom. Conclusion: Poor CVR response is more often found in higher degree of steno-occlusion. Even inconclusive predicting incidence of recurrent ischemic stroke, CVR that reflects the capacity of neuro-autoregulation.

Key-words:

Cerebral perfusion - cerebrovascular steno-occlusive disease - functional magnetic resonance imaging - stimuli stress test

Financial support and sponsorship

Nil.




Publication History

Received: 10 May 2020

Accepted: 11 June 2020

Article published online:
16 August 2022

© 2020. Asian Congress of Neurological Surgeons. This is an open access article published by Thieme under the terms of the Creative Commons Attribution-NonDerivative-NonCommercial License, permitting copying and reproduction so long as the original work is given appropriate credit. Contents may not be used for commercial purposes, or adapted, remixed, transformed or built upon. (https://creativecommons.org/licenses/by-nc-nd/4.0/)

Thieme Medical and Scientific Publishers Pvt. Ltd.
A-12, 2nd Floor, Sector 2, Noida-201301 UP, India

 

  • References

  • 1 Powers WJ, Clarke WR, Grubb RL Jr, Videen TO, Adams HP Jr, Derdeyn CP,et al. Extracranial-intracranial bypass surgery for stroke prevention in hemodynamic cerebral ischemia: The Carotid Occlusion Surgery Study randomized trial. JAMA 2011;306:1983-92.
  • 2 Vagal AS, Leach JL, Fernandez-Ulloa M, Zuccarello M. The acetazolamide challenge: Techniques and applications in the evaluation of chronic cerebral ischemia. AJNR Am J Neuroradiol 2009;30:876-84.
  • 3 Eskey CJ, Sanelli PC. Perfusion imaging of cerebrovascular reserve. Neuroimaging Clin N Am 2005;15:367-81, xi.
  • 4 Powers WJ, Press GA, Grubb RL Jr., Gado M, Raichle ME. The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med 1987;106:27-34.
  • 5 Rogg J, Rutigliano M, Yonas H, Johnson DW, Pentheny S, Latchaw RE. The acetazolamide challenge: Imaging techniques designed to evaluate cerebral blood flow reserve. AJR Am J Roentgenol 1989;153:605-12.
  • 6 Sobczyk O, Battisti-Charbonney A, Fierstra J, Mandell DM, Poublanc J, Crawley AP, et al. A conceptual model for CO-induced redistribution of cerebral blood flow with experimental confirmation using BOLD MRI. Neuroimage 2014;92:56-68.
  • 7 Mohan KM, Wolfe CD, Rudd AG, Heuschmann PU, Kolominsky-Rabas PL, Grieve AP. Risk and cumulative risk of stroke recurrence: A systematic review and meta-analysis. Stroke 2011;42:1489-94.