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Increased stroke risk predicted by compromised cerebral blood flow reactivity
H Yonas1, H A Smith, S R Durham
1Department of Neurological Surgery, University of Pittsburgh School of Medicine, Pennsylvania.
Journal of Neurosurgery
|October 1, 1993
Summary
Individuals with compromised cerebral blood flow (CBF) reserves and low baseline flow face a significantly higher risk of stroke. This finding aids in identifying high-risk patients with symptomatic carotid stenosis or occlusion.
Area of Science:
- Neurology
- Radiology
- Vascular Medicine
Background:
- Symptomatic carotid stenosis or occlusion poses a significant stroke risk.
- Assessing cerebral blood flow (CBF) reserves is crucial for risk stratification.
Purpose of the Study:
- To determine stroke risk in patients with symptomatic carotid stenosis/occlusion by evaluating CBF reserves.
- To identify predictors of stroke incidence based on vascular reactivity and baseline CBF.
Main Methods:
- Two consecutive xenon/computerized tomography (Xe/CT) CBF studies were performed, with acetazolamide administered before the second study.
- Patients were grouped based on CBF reduction (>5%) and baseline flow (<45 cc/100 gm/min).
- Sixty-eight individuals were followed for a mean of 24 months.
Main Results:
- Group 2 (compromised reserves, low baseline flow) had a 36% stroke incidence, significantly higher than Group 1 (4.4%).
- Group 2 patients had a 12.6 times greater risk of ipsilateral stroke (p = 0.0007).
- Baseline CBF, stroke history, TIA history, and stenosis degree did not predict stroke risk.
Conclusions:
- Significantly compromised vascular reserves combined with low initial CBF identify patients at substantially increased risk of ipsilateral stroke.
- This assessment method can improve stroke risk prediction in patients with symptomatic carotid disease.
- Vascular reserve assessment is a valuable tool for managing patients with carotid stenosis or occlusion.