Increased oxygen extraction fraction is associated with prior ischemic events in patients with carotid occlusion.

BACKGROUND AND PURPOSE The purpose of our study was to investigate the relationship between misery perfusion (increased oxygen extraction fraction, OEF) and baseline risk factors in patients with carotid occlusion. METHODS One-hundred seventeen patients with atherosclerotic carotid occlusion were studied prospectively by clinical evaluation, laboratory testing, and positron emission tomography (PET). PET measurements of cerebral blood flow (CBF), cerebral blood volume (CBV), and OEF were made on enrollment in the study. Increased ipsilateral OEF was identified by comparison with 18 normal control subjects. Twenty-five baseline clinical, epidemiological, and arteriographic risk factors were assessed on study entry. Student t tests, chi(2) tests, and Fisher exact tests with Bonferroni correction were used to assess statistical significance (P<.05). RESULTS Of 117 patients, 44 had increased OEF distal to the occluded carotid and 73 had normal OEFs. Thirty-nine of the 81 patients with prior ipsilateral ischemic symptoms had high OEFs (42%), whereas only 5 of the 31 asymptomatic patients had high OEFs (16%, P<.001). All of the other baseline risk factors were similar between the two groups of patients. CONCLUSIONS Investigations of the relationship between hemodynamic factors and stroke risk must take into account the lower frequency of hemodynamic abnormalities in asymptomatic patients.

[1]  B. Widder,et al.  Course of Carotid Artery Occlusions With Impaired Cerebrovascular Reactivity , 1992, Stroke.

[2]  R. Sacco,et al.  Race-ethnicity and determinants of intracranial atherosclerotic cerebral infarction. The Northern Manhattan Stroke Study. , 1995, Stroke.

[3]  C. Tulleken,et al.  Symptomatic carotid artery occlusion. A reappraisal of hemodynamic factors. , 1997, Stroke.

[4]  Robert A. Zimmerman,et al.  Special report from the National Institute of Neurological Disorders and Stroke. Classification of cerebrovascular diseases III. , 1990, Stroke.

[5]  J. Dobkin,et al.  Cerebral vasocapacitance and TIAs , 1989, Neurology.

[6]  R. N. Baker,et al.  Prognosis in patients with transient cerebral ischemic attacks , 1968, Neurology.

[7]  D Comar,et al.  Reversal of Focal "Misery‐Perfusion Syndrome" By Extra‐Intracranial Arterial Bypass in Hemodynamic Cerebral Ischemia: A Case Study with 15O Positron Emission Tomography , 1981, Stroke.

[8]  M. Hennerici,et al.  Spontaneous history of asymptomatic internal carotid occlusion. , 1986, Stroke.

[9]  T. Yanagihara Cerebral Anoxia: An Improved In Vitro Model for Biochemical Study , 1973, Stroke.

[10]  P. Whelton,et al.  Risk of stroke in male cigarette smokers. , 1987, The New England journal of medicine.

[11]  Marcus E. Raichle,et al.  Measurement of regional cerebral blood volume by emission tomography , 1978, Annals of neurology.

[12]  W. Willett,et al.  Cigarette smoking and risk of stroke in middle-aged women. , 1988, The New England journal of medicine.

[13]  P. Gorelick,et al.  Stroke prevention. , 1995, Archives of neurology.

[14]  Peter Herscovitch,et al.  Brain blood flow measured with intravenous H/sub 2//sup 15/O. I. Theory and error analysis , 1983 .

[15]  G. Hankey,et al.  Prognosis of Symptomatic Carotid Artery Occlusion , 1991 .

[16]  C. Viscoli,et al.  A prognostic system for transient ischemia or minor stroke. , 1991, Annals of internal medicine.

[17]  Role of Doppler ultrasound in screening for carotid atherosclerotic disease. , 1996, Academic radiology.

[18]  H. Barnett Hemodynamic cerebral ischemia. An appeal for systematic data gathering prior to a new EC/IC trial. , 1997, Stroke.

[19]  J Bamford,et al.  Prognosis of transient ischemic attacks in the Oxfordshire Community Stroke Project. , 1990, Stroke.

[20]  M. Raichle,et al.  Cerebral Blood Flow and Cerebral Metabolic Rate of Oxygen Requirements for Cerebral Function and Viability in Humans , 1985, Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism.

[21]  Preparation of short half-lived radioactive gases for medical studies. , 1968, Radiation research.

[22]  R. D'Agostino,et al.  Fibrinogen and risk of cardiovascular disease. The Framingham Study. , 1987, JAMA.

[23]  R B D'Agostino,et al.  Cigarette smoking as a risk factor for stroke. The Framingham Study. , 1988, JAMA.

[24]  R. Frye,et al.  A population-based model of risk factors for ischemic stroke , 1996, Neurology.

[25]  R. Sacco,et al.  Risk factors and outcomes for ischemic stroke. , 1995, Neurology.

[26]  M. Mintun,et al.  Brain oxygen utilization measured with O-15 radiotracers and positron emission tomography. , 1984, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[27]  L. Elveback,et al.  Carotid and vertebral‐basilar transient ischemic attacks: Effect of anticoagulants, hypertension, and cardiac disorders on survival and stroke occurrence— A population study , 1978, Annals of neurology.

[28]  A. Belanger,et al.  The Framingham study. , 1976, British medical journal.

[29]  P A Wolf,et al.  Survival and recurrence following stroke. The Framingham study. , 1982, Stroke.

[30]  W. Powers Cerebral hemodynamics in ischemic cerebrovascular disease , 1991, Annals of neurology.

[31]  M. Ter-pogossian,et al.  Preparation of millicurie quantities of oxygen‐15 labeled water , 1969 .

[32]  J. Whisnant,et al.  Factors affecting survival and occurrence of stroke in patients with transient ischemic attacks. , 1994, Mayo Clinic proceedings.

[33]  M. Mintun,et al.  Brain blood flow measured with intravenous H2(15)O. II. Implementation and validation. , 1983, Journal of nuclear medicine : official publication, Society of Nuclear Medicine.

[34]  L. Wilkins Predictors of Major Vascular Events in Patients With a Transient Ischemic Attack or Nondisabling Stroke , 1993, Stroke.

[35]  E. Sobel,et al.  Stroke in the Lehigh Valley , 1987, Neurology.

[36]  L Wilhelmsen,et al.  Analysis of risk factors for stroke in a cohort of men born in 1913. , 1987, The New England journal of medicine.

[37]  R. Sacco,et al.  Race-ethnic differences in stroke risk factors among hospitalized patients with cerebral infarction , 1995, Neurology.

[38]  M. Raichle,et al.  The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation. , 1987, Annals of internal medicine.

[39]  R. Wise,et al.  EVALUATION OF CEREBRAL PERFUSION RESERVE IN PATIENTS WITH CAROTID-ARTERY OCCLUSION , 1984, The Lancet.

[40]  J. Wade,et al.  Hemoglobin concentration and prognosis in symptomatic obstructive cerebrovascular disease. , 1987, Stroke.

[41]  Daniel B Hier,et al.  Stroke recurrence within 2 years after ischemic infarction. , 1991, Stroke.

[42]  B. Widder,et al.  Course of Cerebrovascular Reactivity in Patients With Carotid Artery Occlusions , 1994, Stroke.

[43]  P. Wolf,et al.  Manifestations of coronary disease predisposing to stroke. The Framingham study. , 1983, JAMA.

[44]  P. Wolf,et al.  Hemoglobin and the risk of cerebral infarction: the Framingham Study. , 1972, Stroke.

[45]  W J Powers,et al.  Role of Doppler US in screening for carotid atherosclerotic disease. , 1995, Radiology.

[46]  A. Algra,et al.  Does Cerebral Infarction After a Previous Warning Occur in the Same Vascular Territory? , 1993, Stroke.

[47]  M. Raichle,et al.  A Stereotactic Method of Anatomical Localization for Positron Emission Tomography , 1985, Journal of computer assisted tomography.

[48]  J. Dambrosia,et al.  Risk factors for ischemic stroke: A prospective study in Rochester, Minnesota , 1987, Annals of neurology.

[49]  T. Price,et al.  Cooperative study of hospital frequency and character of transient ischemic attacks. VIII. Risk factors. , 1978, JAMA.