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Outcome of carotid artery occlusion is predicted by cerebrovascular reactivity
F Vernieri1, P Pasqualetti, F Passarelli
1AFaR CRCCS: Divisione di Neurologia-Ospedale Fatebenefratelli, Isola Tiberina, Roma, Italy. fbfisola@tin.it
Insights
Impaired cerebrovascular reactivity, measured by breath-holding index (BHI), predicts future ischemic events in patients with internal carotid artery occlusion. Lower BHI values indicate higher risk.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Internal carotid artery occlusion poses a risk for ischemic events.
- Prognostic indicators for these patients are crucial for risk stratification.
- Baseline characteristics and hemodynamic status may offer predictive insights.
Purpose of the Study:
- To determine if intracranial hemodynamic status predicts outcomes in internal carotid artery occlusion.
- To assess the role of prior cerebrovascular symptoms and baseline characteristics.
- To investigate prognostic indications based on cerebral hemodynamics.
Main Methods:
- Transcranial Doppler ultrasonography used to assess cerebral hemodynamics.
- Breath-holding index (BHI) calculated to measure cerebrovascular reactivity to apnea.
- Prospective follow-up of 65 patients with internal carotid artery occlusion over a median of 24 months.
Main Results:
- Lower BHI values in the middle cerebral arteries ipsilateral to occlusion were significantly associated with increased risk of ischemic events (P=0.002).
- Older age was also significantly associated with higher risk (P=0.003).
- A BHI value of <0.69 was identified as a predictor of subsequent ischemic events.
Conclusions:
- Impaired cerebrovascular reactivity, indicated by low BHI, is a significant predictor of cerebral ischemic events in patients with carotid occlusion.
- These findings highlight the prognostic value of hemodynamic assessment in managing carotid artery disease.
Background And Purpose:
The purpose of this study was to investigate the possibility of obtaining prognostic indications in patients with internal carotid occlusion on the basis of intracranial hemodynamic status, presence of previous symptoms of cerebrovascular failure, and baseline characteristics.
Methods:
Cerebral hemodynamics were studied with transcranial Doppler ultrasonography. Cerebrovascular reactivity to apnea was calculated by means of the breath-holding index (BHI) in the middle cerebral arteries. Sixty-five patients with internal carotid artery occlusion were followed-up prospectively (median, 24 months), 23 patients were asymptomatic and 42 symptomatic (20 with transient ischemic attack and 22 with stroke).
Results:
During the follow-up period, 11 symptomatic patients and 1 asymptomatic patient had another ischemic event ipsilateral to carotid occlusion. Among factors considered, only lower BHI values in the middle cerebral arteries ipsilateral to carotid occlusion and older age were significantly associated with the risk of developing symptoms (P=0.002 and P=0.003, respectively; Cox regression multivariate analysis). Based on our data, a cut point of the BHI value for distinguishing between pathological and normal cerebrovascular reactivity was determined to be 0.69. All patients except one, who developed TIA or stroke during the follow-up period, had BHI values ipsilateral to carotid occlusion of <0.69.
Conclusions:
These data suggest that impaired cerebrovascular reactivity is predictive for cerebral ischemic events in patients with carotid occlusion.