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Regional cerebral blood flow in patients with vertebrobasilar disease
Insights
Patients with occlusive vertebrobasilar disease show reduced regional cerebral blood flow (rCBF). Combined vertebrobasilar and carotid artery lesions significantly lower rCBF compared to carotid lesions alone.
Area of Science:
- Neurology
- Vascular Medicine
- Neuroimaging
Background:
- Occlusive vertebrobasilar disease affects cerebral blood flow.
- Understanding regional cerebral blood flow (rCBF) is crucial for diagnosing and managing cerebrovascular conditions.
Purpose of the Study:
- To investigate changes in rCBF in patients with occlusive vertebrobasilar disease.
- To compare rCBF in patients with limited vertebrobasilar lesions versus combined vertebrobasilar and carotid artery lesions.
Main Methods:
- Studied 50 patients with severe stenosis or occlusion in the vertebrobasilar artery territory using angiography.
- Measured rCBF with the intravenous xenon 133 technique.
- Compared rCBF in patient groups (limited VB, combined VB-C, limited C) and normal subjects.
Main Results:
- Mean rCBF was significantly decreased in the 50 patients compared to normal subjects.
- The combined VB-C group showed significantly lower mean rCBF than the limited C group.
- No significant rCBF difference was found between the limited VB group and normal subjects.
- Impaired cerebral autoregulation was observed in 54% of tested patients.
Conclusions:
- Occlusive vertebrobasilar disease, particularly with combined carotid involvement, leads to reduced rCBF.
- Cerebral autoregulation is frequently impaired in these patients.
- Hemispheric rCBF is lower in patients with carotid system transient ischemic attacks than in those with vertebrobasilar system TIAs.
Abstract:
We have investigated the changes in regional cerebral blood flow (rCBF) in patients with occlusive vertebrobasilar disease. Fifty patients who showed severe stenosis or occlusion of the vertebrobasilar artery territory were studied by angiography. Lesions in 13 of these patients were limited to the vertebrobasilar artery (limited VB group), and 37 patients showed combined vertebrobasilar/carotid artery lesions (combined VB-C group). Measurements of rCBF in the group of 50 patients using the intravenous xenon 133 technique showed that there was a significant decrease in the mean rCBF (47.5 +/- 1.4 ml/100 gm/min) as compared with 19 age-matched normal subjects (54.9 +/- 1.8 ml/100 gm/min. There was also a significant difference in mean rCBF between the combined VB-C group (45.6 +/- 1.5 ml/100 gm/min) and a group of 153 patients with limited carotid artery lesions (C group, 49.8 +/- 1.0 ml/100 gm/min). However, no significant difference in mean rCBF was found between the limited VB group and normal subjects. There were no differences in rCBF when evaluated according to the presence or absence of angiographic collateral circulation via the posterior communicating artery (Pcom). Good correlation was found between mean rCBF and direction of collateral flow via the Pcom (p less than 0.05). The value of hemispheric rCBF of patients with carotid system transient ischemic attacks (TIAs) was significantly lower than that of patients with vertebrobasilar system TIAs (p less than 0.02). In cerebral autoregulation tests of 24 patients with occlusive vertebrobasilar disease (7 patients from the limited VB group and 17 patients from the combined VB-C group), 13 of these 24 patients (54%) showed an impairment of autoregulation.