Benefit of CEA in Patients with Contralateral Occlusion. Abstract, ExecutiveSummary and Final Report

摘要

Stenosis or occlusion of the internal carotid artery (ICA) is common among thosewho have strokes or transient ischemic attacks (TIAs) and is associated with a high rate of a subsequent stroke. An increased risk of stroke was found in symptomatic patients with severely compromised cerebrovascular reserves by a retrospective study. Webtser et al. Reported a 36% rate of stroke associated with stenotic patients that demonstrate a 'steal' phenomenon with stable xenon-enhanced computed tomography (Xe/CT) cerebral blood flow (CBF) methods. Cerebrovascular reserves were assessed by inducing a vasodilator challenge with acetazolamide, a carbonic anhydrase inhibitor. The cerebral tissue acidosis dramatically increases the blood flow to uncompromised territories of the brain, whereas territories that are hemodynamically compromised either are unchanged or do not show increased blood flow because vessels are presumably already maximally dilated, and those that are most severely compromised demonstrate a 'steal' phenomenon (i.e., a decrease in CBF).