Importance of Hemodynamic Factors in the Prognosis of Symptomatic Carotid Occlusion
JAMAPublished 23 September 1998
Robert L. Grubb
Citations799
SJR quartileQ1
SJR score5.35
SNIP10.71
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
Stage II hemodynamic failure defines a subgroup of patients with symptomatic carotid occlusion who are at high risk for subsequent stroke when treated medically, and a randomized trial evaluating surgical revascularization in this high-risk subgroup is warranted.
Abstract
Stage II hemodynamic failure defines a subgroup of patients with symptomatic carotid occlusion who are at high risk for subsequent stroke when treated medically. A randomized trial evaluating surgical revascularization in this high-risk subgroup is warranted.
Keywords
Medicine
New England Journal of MedicineBeneficial Effect of Carotid Endarterectomy in Symptomatic Patients with High-Grade Carotid Stenosis
8,368 Citations1991H. J. M. Barnett
Carotid endarterectomy is highly beneficial to patients with recent hemispheric and retinal transient ischemic attacks or nondisabling strokes and ipsilateral high-grade stenosis of the internal carotid artery.
New England Journal of MedicineFailure of Extracranial–Intracranial Arterial Bypass to Reduce the Risk of Ischemic Stroke
1,553 Citations1985The EC/IC Bypass Study Group*
This study failed to confirm the hypothesis that extracranial-intracranIAL anastomosis is effective in preventing cerebral ischemia in patients with atherosclerotic arterial disease in the carotid and middle cerebral arteries.
Annals of NeurologyCerebral hemodynamics in ischemic cerebrovascular disease
823 Citations1991William J. Powers
Investigation into the importance of hemodynamic factors in ischemic stroke can now be based on accurate assessment of cerebral (not carotid or vertebrobasilar) hemodynamics in the context of other coexisting epidemiological, clinical, hematological, and angiographic risk factors.
StrokeReversal of focal "misery-perfusion syndrome" by extra-intracranial arterial bypass in hemodynamic cerebral ischemia. A case study with 15O positron emission tomography.
727 Citations1981Jean‐Claude Baron, Marie‐Germaine Bousser +4 more
There was a focal mismatch between CBF and oxygen metabolism in the brain supplied by tbe middle cerebral artery where CBF was decreased and OEF increased ("misery-perfusion syndrome" as opposed to "luxury- perfusioa syndrome") and this pattern of abnormalities indicates potential liable tissue.
PubMedBrain oxygen utilization measured with O-15 radiotracers and positron emission tomography.
613 Citations1984M. A. Mintun, Marcus E. Raichle +2 more
The LancetEVALUATION OF CEREBRAL PERFUSION RESERVE IN PATIENTS WITH CAROTID-ARTERY OCCLUSION
573 Citations1984J. M. Gibbs, Klaus L. Leenders +2 more
Regional cerebral blood flow, oxygen utilisation, fractional oxygen extraction, and cerebral blood volume were measured by positron emission tomography in thirty-two patients with internal-carotid-artery occlusion to suggest that the reduction in cerebral perfusion pressure, and hence circulatory reserve, could be most reliably predicted by the ratio of cerebralblood flow to blood volume.
Journal of Computer Assisted TomographyThe ECAT EXACT HR
564 Citations1994K. Wienhard, Magnus Dahlbom +5 more
Due to its special properties, the ECAT EXACT HR can be equally applied to routine clinical brain and whole-body imaging and to noninvasive experimental studies of regional tracer concentrations in medium-sized animals.
Annals of Internal MedicineThe Effect of Hemodynamically Significant Carotid Artery Disease on the Hemodynamic Status of the Cerebral Circulation
474 Citations1987William J. Powers, Gary A. Press +3 more
A significant relationship was found between the PET measurements of cerebral hemodynamics and the arteriographic circulation pattern and the role of hemodynamic factors in the pathogenesis and treatment of cerebrovascular disease cannot be determined from the severity of carotid artery disease alone.
Journal of Cerebral Blood Flow & MetabolismCerebral Blood Flow and Cerebral Metabolic Rate of Oxygen Requirements for Cerebral Function and Viability in Humans
427 Citations1985William J. Powers, Robert L. Grubb +2 more
Data indicate that quantitative regional measurements of rCMRO2 with PET accurately distinguish viable from nonviable cerebral tissue and may be useful in the prospective identification of patients with reversible ischemia.
StrokeSymptomatic Carotid Artery Occlusion
343 Citations1997Catharina J.M. Klijn, L. Jaap Kappelle +2 more
Because a compromised cerebral blood flow may be an important causal factor in patients with symptomatic carotid artery occlusion, medical and surgical options for treatment are reviewed in this light.
Physics in Medicine and BiologyPhysical performance of a positron tomograph for brain imaging with retractable septa
293 Citations1992T.J. Spinks, Terry Jones +8 more
In spite of the increase in scatter when septa are retracted, the increased efficiency in the 3D mode of acquisition yields distinct advantages, particularly in the many studies where tracer concentration is low and consequently where dead time and random rates are less important.
New England Journal of MedicineClinical and Angiographic Features of Carotid Transient Ischemic Attacks
263 Citations1977Michael S. Pessin, Gordon W. Duncan +2 more
There are several distinct groups of patients with carotid transient ischemic attacks, and separate hemisphere and ocular attacks in the same patient correlated with tightcarotid stenosis, the study indicates.
Journal of Neurology Neurosurgery & PsychiatryEvidence of misery perfusion and risk for recurrent stroke in major cerebral arterial occlusive diseases from PET.
263 Citations1996Hiroshi Yamauchi, Hidenao Fukuyama +7 more
These findings contradict conclusions of a previous study and suggest that patients with major cerebral arterial occlusive diseases and misery perfusion have a high risk for recurrent ischaemic stroke.
Archives of NeurologyThe Risk of Stroke in Patients With First-Ever Retinal vs Hemispheric Transient Ischemic Attacks and High-grade Carotid Stenosis
188 Citations1995Jonathan Y. Streifler, Michael Eliasziw +6 more
This study is the first report on the expected outcome for medically treated patients with high-grade carotid stenosis in whom the first-ever event was either an RTIA or HTIA, and in comparison with HTIAs, patients with RTIAs still have a better prognosis.
StrokeEarly collateral blood supply and late parenchymal brain damage in patients with middle cerebral artery occlusion.
174 Citations1989L. Bozzao, L. M. Fantozzi +3 more
The presence of a collateral circulation during the first few hours after the stroke reduced the size of the final parenchymal brain damage in patients with middle cerebral artery stem-trunk occlusion and the collateral blood supply was more efficient in patients who had no significant stenosing lesions of the extracranial internal carotid artery.
NeurologyCorrelation of arteriographic findings and symptoms in cerebrovascular disease
168 Citations1980B L Thiele, J. V. Young +3 more
Signs of cerebral ischemia are more likely to be related to ulceration than to hemodynamically significant lesions, and the risk of stroke seems greatest when there is also intracerebral siphon disease or anatomic anomaly of the circle of Willis.
NeurologyExtracranial‐intracranial bypass surgery
159 Citations1984William J. Powers, W. R. Wayne Martin +3 more
After superficial temporal artery-middle cerebral artery bypass, cerebral blood flow to the operated hemisphere increased and with th postoperative increase in hemispheric CBF, there was a decrease in oxygen extraction, but no change in blood volume o oxygen metabolism.
Journal of Neurology Neurosurgery & PsychiatryCerebral haemodynamic changes after extracranial-intracranial bypass surgery.
130 Citations1987J. M. Gibbs, Richard G. Wise +3 more
Post-operative findings were consistent with an increase of regional cerebral perfusion pressure as a result of the bypass procedure, although this effect is potentially of value, those patients with most to gain from bypass surgery may also run the highest risk of peri-operative cerebral ischaemia.
StrokeEffects of extra-intracranial arterial bypass on cerebral blood flow and oxygen metabolism in humans.
129 Citations1985Yves Samson, Jean‐Claude Baron +5 more
The study of patients with a successful unilateral extra-intracranial arterial by-pass suggests that long-standing hemodynamic failure may induce a metabolic depression that is still potentially reversible by surgical revascularization.
Annals of NeurologyInfluence of cerebral hemodynamics on stroke risk: One‐year follow‐up of 30 medically treated patients
128 Citations1989William J. Powers, Lee W. Tempel +1 more
In this small sample, there is no evidence that PET evidence of abnormal cerebral hemodynamics identifies a subgroup of patients at higher risk for early stroke if treated medically with antithrombotic drugs.
StrokeIncreased Oxygen Extraction Fraction Is Associated With Prior Ischemic Events in Patients With Carotid Occlusion
123 Citations1998Colin P. Derdeyn, Kent D. Yundt +4 more
Investigating the relationship between misery perfusion (increased oxygen extraction fraction, OEF) and baseline risk factors in patients with carotid occlusion found it necessary to take into account the lower frequency of hemodynamic abnormalities in asymptomatic patients.
StrokeEffect of Acetazolamide Reactivity and Long-term Outcome in Patients With Major Cerebral Artery Occlusive Diseases
102 Citations1998Chiaki Yokota, Yasuhiro Hasegawa +2 more
The present results demonstrate that reduced vasodilatory capacity does not play a major role in stroke recurrence and antihypertensive therapy appears to reduce strokes even in patients with hemodynamically significant arterial diseases.
The LancetEVALUATION OF CEREBRAL PERFUSION RESERVE IN PATIENTS WITH CAROTID-ARTERY OCCLUSION
89 Citations1984J. M. Gibbs, Klaus L. Leenders +2 more
Regional cerebral blood flow, oxygen utilisation, fractional oxygen extraction, and cerebral blood volume were measured by positron emission tomography in thirty-two patients with internal-carotid-artery occlusion to suggest that the reduction in cerebral perfusion pressure, and hence circulatory reserve, could be most reliably predicted by the ratio of cerebralblood flow to blood volume.
Cerebrovascular DiseasesPrognosis of Symptomatic Carotid Artery Occlusion
87 Citations1991Graeme J. Hankey, Charles Warlow
This work has reviewed the twelve prospective follow-up studies of angiographically documented symptomatic carotid artery occlusion in a total of 1,261 patients who were followed up over a mean period of 45 years.
Journal of Cerebral Blood Flow & MetabolismBrain Blood Volume, Flow, and Oxygen Utilization Measured with <sup>15</sup> O Radiotracers and Positron Emission Tomography: Revised Metabolic Computations
84 Citations1987Tom O. Videen, Joel S. Perlmutter +2 more
The methods for calculating regional blood volume, flow, oxygen extraction, and oxygen utilization from positron emission tomography data obtained using 15O-labeled radiotracers are revised to include radioactive decay explicitly within the model equations.