Abstract
Patients with complete carotid artery occlusion comprise approximately 15% of those with carotid territory transient ischemic attacks or infarction [1–3]. Prevention of subsequent stroke in patients with carotid artery occlusion remains a difficult challenge. The overall risk of subsequent stroke is 7% per year and the risk of stroke ipsilateral to the occluded carotid artery is 5.9% per year [4]. These risks persist in the face of platelet inhibitory drugs and anticoagulants [5]. The importance of hemodynamic factors in the prognosis of carotid occlusion and the role of surgical re-vascularization in the treatment of these patients has been a subject of controversy for many years. The technique of extracranial-intracranial (EC/IC) arterial bypass surgery was developed in the late 1960’s and applied to patients with carotid occlusion in an attempt to prevent subsequent stroke by improving the hemodynamic status of the cerebral circulation distal to the occluded vessel. The results of an international multicenter randomized trial to determine the efficacy of EC/IC arterial bypass for the prevention of subsequent stroke was reported in 1985. Among 808 patients with symptomatic carotid occlusion who were randomized, no benefit of superficial temporal artery — middle cerebral artery (STA-MCA) bypass surgery could be demonstrated [6]. Based on the results of this trial, EC/IC bypass was generally abandoned as a treatment for symptomatic carotid artery occlusion.
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References
Balow J, Alter M, Resch JA. Cerebral thromboembolism. A clinical appraisal of 100 cases. Neurology 1966; 16:559–564.
Pessin MS, Duncan GW, Mohr JP, et al. Clinical and angiographic features of carotid transient ischemic attacks. N Engl J Med 1977; 296:358–362.
Thiele BL, Young JV, Chikos PM, et al. Correlation of artériographie findings and symptoms in cerebrovascular disease. Neurology 1980; 30:1041–1046.
Hankey GJ, Warlow CP. Prognosis of symptomatic carotid occlusion-an overview. Cerebrovasc Dis 1991; 1:245–256.
Grubb RL Jr, Derdeyn CP, Fritsch SM, et al. Importance of hemodynamic factors in the prognosis of symptomatic carotid occlusion. JAMA 1998; 280:1055–1060.
EC/IC Bypass Study Group. Failure of extracranial-intracranial arterial bypass to reduce the risk of ischemic stroke. N Engl J Med 1985; 313:1191–1200.
Day AL, Rhoton AL, Jr., Little JR. The extracranial-intracranial bypass study. Surg Neurol 1986; 26:222–226.
Awad, IA, Spetzler, RA: Extracranial-intracranial bypass surgery: a critical analysis in light of the International Cooperative Study. Neurosurgery 1986, 19:655–664.
Yonas H, Pindzola RR. Effect of Acetazolamide Reactivity and Long-term Outcome in Patients with Major Cerebral Artery Occlusive Diseases. Stroke 1998; 29:1742–1744.
Schmiedek P, Piepgras A, Leinsinger G, et al. Improvement of cerebrovascular reserve capacity by EC-IC arterial bypass in patients with ICA occlusion and hemodynamic cerebral ischemia. J Neurosurg 1994; 81:236–244.
Diaz FG, Ausman JI, Mehta B, et al. Acute cerebral revascularization. J Neurosurg 1985; 63:200–209.
Barnett HJM. Hemodynamic cerebral ischemia — An appeal for systematic data gathering prior to a new EC/IC trial. Stroke 1997; 28:1857–1860.
Klijn CJM, Rappelle LJ, Tulleken CAE, et al. Symptomatic carotid artery occlusion: A reappraisal of hemodynamic factors. Stroke 1997; 28:2084–2093.
Derdeyn CP, Grubb RL, Jr, Powers WJ. Cerebral hemodynamic impairment. Neurology 1999; 53:251–259.
Powers WJ. Cerebral hemodynamics in ischemic cerebrovascular disease. Ann Neurol 1991; 29:231–240.
Gibbs JM, Wise RJS, Leenders KL, et al. Evaluation of cerebral perfusion reserve in patients with carotid-artery occlusion. Lancet 1984; 1:310–314.
Grubb, RL, Jr, Powers, WJ. Role of cerebral hemodynamics in ischemic atherosclerotic cerebrovascular disease. Neurosurg Quart 1993; 3:83–102.
Baron JC, Bousser MG, Rey A, et al. Reversal of focal “misery-perfusion syndrome” by extraintracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography. Stroke 1981; 12:454–459.
Inao S, Tadokoro M, Nishino M, et al. Neural activation of the brain with hemodynamic insufficiency. J Cereb Blood Flow Metab 1998; 18:960–967.
Kazumata K, Tanaka N, Ishikawa T, et al. Dissociation of vasoreactivity to acetazolamide and hypercapnia. Comparative study in patients with chronic occlusive major cerebral artery disease. Stroke 1996; 27:2052–2058.
Hasegawa Y, Minematsu K, Matsuoka H, et al. GBF Responses to Acetazolamide and CO2 for the Prediction of Hemodynamic Failure: A PET Study. Stroke 1997; 28:242
Ogawa S, Lee TM, Kay AR, et al. Brain magnetic resonance imaging with contrast dependent on blood oxygenation. Pre Natl Acad Sci 1990; 87:9868–9872.
Ogawa S, Menon RS, Tank DW, et al. Functional brain mapping by blood oxygenation level-dependent contrast magnetic resonance imaging. Biophysical J. 1993; 64:803–812.
Kwong K, Belliveau JW, Chesler DA, et al. Dynamic magnetic resonance imaging of human brain activity during primary sensory stimulation. Proc Natl Acad Sci USA 1992; 89:5675–5679.
Lin W, Paczynski RP, Celik A, et al. Experimental hypoxemic hypoxia: Effects of variation in hematocrit on MR T2⋆ weighted brain images. J Cereb Blood Flow Metab 1998; 18:1018–1021.
Lin W, Paczynski RP, Celik A, et al. Effects of acute normovolemic hemodiulation on T2⋆-weighted images of rat brain. Magn Res Med 1998; 40:857–864.
Lin W, Celik A, Paczynski RP, et al. Quantitative MRI in experimental hypercapnia: Improvement in the relationship between changes in brain R2⋆ and the oxygen saturation of venous blood after correction for changes in the cerebral blood volume. J Cereb Blood Flow Metab 1999; 19:853–862.
Jezzard P, Heineman F, Taylor J, et al. Comparison of EPI gradient-echo contrast changes in eat brain caused by respiratory changes with direct simultaneous evaluation of cerebral oxygenation via a cranial window. NMR in Biomed 1994; 7:35–44.
Kennan RP, Scanley BE, Gore JC. Physiological basis for BOLD MR signal changes due to hypoxia/hyperoxia: Separation of blood volume and magnetic susceptbility effects. Magn Res Med 1997; 37:353–356.
Hayashida K, Hirose Y, Tanaka Y, et al. Stratification of severity by cerebral blood flow, oxygen metabolism and acetazolamide reactivity in patients with cerebrovascular disease. Recent Advances in Biomedical Imaging 1997; 113-119.
Herold S, Brozovic M, Path ERC, et al. Measurement of regional cerebral blood flow, blood volume and oxygen metabohsm in patients with sickle cell disease using positron emission tomography. Stroke 1986; 17:692–698.
Kanno I, Uemura K, Higano S, et al. Oxygen extraction fraction at maximally vasodilated tissue in the ischemic brain estimated from the regional CO2 responsiveness measured by positron emission tomography. J Cereb Blood Flow Metab 1988; 8:227–235.
Hirano T, Minematsu K, Hasegawa Y, et al. Acetazolamide reactivity on 123I-IMP single photon emission computed tomography in patients with major cerebral artery occlusive disease: correlation with positron emission tomography parameters. J Cereb Blood Flow Metab 1994; 14:763–770.
Nariai T, Suzuki R, Hirakawa K, et al. Vascular reserve in chronic cerebral ischemia measured by the acetazolamide challenge test: Comparison with positron emission tomography. AJNR Am J Neuroradiol 1995; 16:563–570.
Sugimori H, Ibayashi S, Fujii K, et al. Can transcranial Doppler really detect reduced cerebral perfusion states? Stroke 1995; 26:2053–2060.
Yokota C, Hasegawa Y, Minematsu K, et al. Effect of acetazolamide reactivity and long-term outcome in patients with major cerebral artery occlusive diseases. Stroke 1998; 29:640–644.
Yamaguchi H, Fukuyama Y, Nagahama Y, et al. Evidence of misery perfusion and risk for recurrent stroke in major cerebral arterial occlusive diseases from PET. J Neurol Neurosurg Psychiatry 1996; 61:18–25.
Yamauchi H, Fukuyama H, Nagahama Y, et al. Significance of increased oxygen extraction fraction in five-year prognosis of major cerebral arterial occlusive diseases. J Nucl Med 1999; 40:1992–1998.
Yonas H, Smith HA, Durham SR, et al. Increased stroke risk predicted by compromised CBF reactivity J Neurosurg 1993; 79:483–489.
Webster MW, Makaroun MS, Steed DL, et al. Compromised cerebral blood flow reactivity is a predictor of stroke in patients with symptomatic carotid artery occlusive disease. J Vasc Surg 1995; 21:338–345.
Kleiser B, Widder B. Course of carotid artery occlusions with impaired cerebrovascular reactivity. Stroke 1992; 23:171–174.
Bornstein NM, Norris JW. Benign outcome of carotid occlusion. Neurology 1989; 39:6–8.
Powers, WJ, Derdeyn CP, Frtisch SM, et al. Benign prognosis of never-symptomatic carotid occlusion. Neurology 2000; 54:878–882.
Widder B, Kleiser B, Krapf H. Course of cerebrovascular reactivity in patients with carotid artery occlusions. Stroke 1994; 25:1963–1967.
Powers WJ, Tempel LW, Grubb RL, Jr. Influence of cerebral hemodynamics on stroke risk: One year follow-up of 30 medically treated patients. Ann Neurol 1989; 25:325–330
Hasegawa Y, Yamaguchi T, Tsuchiya T, et al. Sequential change of hemodynamic reserve in patients with major cerebral artery occlusions or severe stenosis. Neuroradiology 1992; 34:15–21.
Mintun MA, Raichle ME, Martin WRW, et al. Brain oxygen utilization measured with O-15 radiotracers and positron emission tomography. J Nucl Med 1984; 25:177–187.
Videen TO, Perlmutter JS, Herscovitch P, et al. Brain blood volume, blood flow, and oxygen utilization measured with O-15 radiotracers and positron emission tomography: revised metabolic computations. J Cereb Blood Flow Metab 1987; 7:513–516.
Powers WJ, Press GA, Grubb RL Jr, et al. The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. Ann Intern Med 1987; 106:27–34.
Powers WJ, Grubb RL, Jr, Darriet D, et al. Cerebral blood flow and cerebral metabolic rate of oxygen requirements for cerebral function and viability in humans. J Cereb Blood Flow Metab 1985; 5:600–608.
North American Symptomatic Carotid Endarterectomy Trial Collaborators: Beneficial effect of carotid endarterectomy in symptomatic patients with high-grade stenosis. N Engl J Med 1991; 325:445–453.
Powers WJ, Martin WR, Herscovitch P, et al. Extracranial-intracranial bypass surgery: hemodynamic and metabolic effects. Neurology 1984; 34:1168–1174.
Grubb RL, Jr. Management of the patient with carotid occlusion and a single ischemic event. Clin Neurosurg 1986; 33:251–260.
Samson Y, Baron JC, Rousser MG, et al. Effects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabohsm in humans. Stroke 16:609–616,1985.
Gibbs JM, Wise RJ, Thomas DJ, et al. Cerebral haemodynamic changes after extracranial-intracranial bypass surgery. J Neurol Neurosurg Psychiatry 1987; 50:140–150.
Baron JC, Rey A, Guillard A, et al. Non-invasive tomographic imaging of cerebral blood flow (CBF) and oxygen extraction fraction (OFF) in superficial temporal artery to middle cerebral artery (STA-MCA) anastomosis, in Meyer JS, Lechner H, Reivich M, Ott EO (eds): Cerebral Vascular Disease. Amsterdam, Excerpta Medica, 1981, pp 58–64.
Leblanc R, Tyler JL, Mohr G, et al. Hemodynamic and metabolic effects of cerebral revascularization. J Neurosurg 1987; 66:529–535.
Kawamura S, Sayama I, Yasui N, et al. Haemodynamic and metabolic changes following extra-intracranial bypass surgery. Acta Neurochir 1994; 126:135–139.
Bishop CCR, Burnarel KG, Brown M, et al. Reduced response of cerebral blood flow to hypercapnia: restoration by extracranial-intracranial bypass. Brit J Surg 1987; 74:802–804.
Vorstrup S, Brun B, Lassen NA. Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery Stroke 1986; 17:1291–1298.
Batjer H, Devons MD, Purdy PD, et al. Improvement in regional cerebral blood flow and cerebral vasoreactivity after extracranial-intracranial arterial bypass. Neurosurgery 1988; 22:913–919.
Karnik R, Valentin A, Ammerer HP, et al. Evaluation of vasomotor reactivity by transcranial Doppler and acetazolamide test before and after extracranial-intracranial bypass in patients with internal carotid artery occlusions. Stroke 23:812–817,1992.
Anderson DE, McLane MP, Reichman OH, et al. Improved cerebral blood flow and CO2 reactivity after microvascular anastomosis in patients at high risk for recurrent stroke. Neurosurgery 1992; 31:26–34.
Widder B, Kornhuber HH. Extra-intracranial bypass surgery in carotid artery occlusions: who benefits? Neurol Psychiat Brain Res 1994; 2:126–131.
Hornberger J, Wrone E. When to base clinical policies on observational versus randomized trial data. Ann Int Med 1997; 127:697–703.
Derdeyn CP, Yundt KD, Videen T, et al. Temporal stability of hemodynamic stage in patients with carotid occlusion. J Neurosurg 1998; 88:196A–197A.
Fryback DG, Dasbach EJ, Klein R, et al. The Beaver Dame Health Outcomes Study: Initial catalog of health-state quality factors. Med Decis Mak 1993; 13:89–102.
Gage BE, Cardinalli AB, Owens DK. The effect of stroke and stroke prophylaxis with aspirin or warfarin on quality of life. Arch Int Med 1996; 156:1829–1836.
Mark DB, Hlatky MA, Califf RM, et al. Cost effectiveness of thrombolytic therapy with tissue plasminogen activator as compared with streptokinase for acute myocardial infarction. N Engl J Med 1995; 332:1418–1424.
King JT, Glick HA, Mason TJ, et al. Elective surgery for asymptomatic, unrupture, intracranial aneurysms: a cost effectiveness analysis. Journal of Neursurgery 1995; 83:403–412.
Hartunian N, Smart C, Thompson M. The incidence and economic costs of cancer, motor vehicle injuries, coronary heart disease, and stroke: a comparative analysis. American Journal of Public Health 1980; 70:1249–1260.
Smurawaska LT, Alexandrov AV, Blandin CF, et al. Cost of acute stroke care in Toronto, Canada. Stroke 1994; 25:1628–1631.
Taylor TN, Davis PH, Torner JC, et al. Lifetime cost of stroke in the United States. Stroke 1996; 27:1459–1466.
Thorngren M, Westling B. Utilization of health care resources after stroke. A population based study of 258 hospitalized cases followed during the first year. Acta Neurol Scand 1991; 84:303–310.
Kupersmith J, Holmes-Rovner M, Hogan A, et al. Cost-effectivenss analysis in heart disease. Part III: Ishemia, congestive heart failure, and arrhythmias. Prog Cardiovasc Dis 1995; 37:(5) 307–346.
Broderick JP, Brott T, Kothari R, et al. The Greater Cincinnati/Northern Kentucky Stroke Study: preliminary first-ever and total incidence rates of stroke among blacks. Stroke 1998; 29:415–421.
Sacco RL, Kargman DE, Gu Q, et al. Race-Ethnicity and determinants of intracranial atherosclerotic cerebral infarction. Stroke 1995; 26:14–20.
Hsi DC, Moscoe LM, Kurshat WM. Epidemiology of carotid endarterectomy among Medicare beneficiaries: 1985–1996 update. Stroke 1998; 29:346–350.
Karp HR, Flanders WD, Shipp CC, et al. Carotid endarterectomy among Medicare beneficiaries: a statewide evaluation of appropriateness and outcome. Stroke 1998; 29:46–52.
Bogousslavsky J, Hachinski VC, Boughner DR, et al. Cardiac and arterial lesions in transient ischemic attacks. Arch Neurol 1986; 43:223–228.
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Grubb, R.L., Powers, W.J. (2003). Cerebral Hemodynamics and Stroke Risk in Patients with Complete Carotid Artery Occlusion: Is There a Role for Cerebral Revascularization?. In: Cerebral Blood Flow. Update in Intensive Care Medicine, vol 37. Springer, Berlin, Heidelberg. https://doi.org/10.1007/978-3-642-56036-1_21
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DOI: https://doi.org/10.1007/978-3-642-56036-1_21
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