open access

Vol 76, No 1 (2017)
Original article
Submitted: 2016-03-11
Accepted: 2016-05-28
Published online: 2016-07-04
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Morphometric evaluation of the delayed cerebral arteries response to acetazolamide test in patients with chronic carotid artery stenosis using computed tomography angiography

A. Szarmach, P. J. Winklewski, G. Halena, M. Kaszubowski, J. Dzierżanowski, M. Piskunowicz, E. Szurowska, A. F. Frydrychowski
·
Pubmed: 27830888
·
Folia Morphol 2017;76(1):10-14.

open access

Vol 76, No 1 (2017)
ORIGINAL ARTICLES
Submitted: 2016-03-11
Accepted: 2016-05-28
Published online: 2016-07-04

Abstract

Background: The evidence accumulates that the response to acetazolamide test is delayed on the ipsilateral side to stenosis. However, the effect of acetazolamide beyond 30 min after acetazolamide administration remains unknown. The aim of this study was to assess the diameters of anterior cerebral arteries (ACAs), middle cerebral arteries (MCAs) and posterior cerebral arteries (PCAs) before and 60 min after the acetazolamide test.

Materials and methods: Seventeen patients with carotid artery stenosis ≥ 90% on the ipsilateral side and ≤ 50% on the contralateral side were enrolled into the study. Diagnosis was based on ultrasonography examination and was confirmed using digital subtractive angiography. In all patients, two computed tomography angiography examinations were carried out; the first was performed before the acetazolamide administration, while the second one was carried out 60 min after injections.

Results: In response to the acetazolamide test: PCA diameter diminished in both ipsi- and contra-lateral side to stenosis (from 1.31 to 1.24 mm and from 1.23 to 1.15 mm, respectively), ACA and MCA decreased in the contralateral side to the stenosis (from 1.33 to 1.26 mm and from 2.75 to 2.66 mm, respectively), ACA and MCA increased in the ipsilateral side to the stenosis (from 1.29 to 1.46 mm and from 2.77 to 2.96 mm, respectively). All changes were statistically significant.

Conclusions: There were significant differences in reactivity to acetazolamide challenge between the internal carotid artery (ICA) and vertebrobasilar circulation in patients suffering from chronic carotid artery stenosis. Within the ICA territory, ACA and MCA responses vary in the affected and not affected side.  

Abstract

Background: The evidence accumulates that the response to acetazolamide test is delayed on the ipsilateral side to stenosis. However, the effect of acetazolamide beyond 30 min after acetazolamide administration remains unknown. The aim of this study was to assess the diameters of anterior cerebral arteries (ACAs), middle cerebral arteries (MCAs) and posterior cerebral arteries (PCAs) before and 60 min after the acetazolamide test.

Materials and methods: Seventeen patients with carotid artery stenosis ≥ 90% on the ipsilateral side and ≤ 50% on the contralateral side were enrolled into the study. Diagnosis was based on ultrasonography examination and was confirmed using digital subtractive angiography. In all patients, two computed tomography angiography examinations were carried out; the first was performed before the acetazolamide administration, while the second one was carried out 60 min after injections.

Results: In response to the acetazolamide test: PCA diameter diminished in both ipsi- and contra-lateral side to stenosis (from 1.31 to 1.24 mm and from 1.23 to 1.15 mm, respectively), ACA and MCA decreased in the contralateral side to the stenosis (from 1.33 to 1.26 mm and from 2.75 to 2.66 mm, respectively), ACA and MCA increased in the ipsilateral side to the stenosis (from 1.29 to 1.46 mm and from 2.77 to 2.96 mm, respectively). All changes were statistically significant.

Conclusions: There were significant differences in reactivity to acetazolamide challenge between the internal carotid artery (ICA) and vertebrobasilar circulation in patients suffering from chronic carotid artery stenosis. Within the ICA territory, ACA and MCA responses vary in the affected and not affected side.  

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Keywords

cerebral arteries, computed tomography angiography, acetazolamide test, cerebral regional reactivity

About this article
Title

Morphometric evaluation of the delayed cerebral arteries response to acetazolamide test in patients with chronic carotid artery stenosis using computed tomography angiography

Journal

Folia Morphologica

Issue

Vol 76, No 1 (2017)

Article type

Original article

Pages

10-14

Published online

2016-07-04

Page views

3134

Article views/downloads

1328

DOI

10.5603/FM.a2016.0034

Pubmed

27830888

Bibliographic record

Folia Morphol 2017;76(1):10-14.

Keywords

cerebral arteries
computed tomography angiography
acetazolamide test
cerebral regional reactivity

Authors

A. Szarmach
P. J. Winklewski
G. Halena
M. Kaszubowski
J. Dzierżanowski
M. Piskunowicz
E. Szurowska
A. F. Frydrychowski

References (21)
  1. Aamand R, Skewes J, Møller A, et al. Enhancing effects of acetazolamide on neuronal activity correlate with enhanced visual processing ability in humans. Neuropharmacology. 2011; 61(5-6): 900–908.
  2. Ainslie PN, Duffin J. Integration of cerebrovascular CO2 reactivity and chemoreflex control of breathing: mechanisms of regulation, measurement, and interpretation. Am J Physiol Regul Integr Comp Physiol. 2009; 296(5): R1473–R1495.
  3. Barnett HJ. Hemodynamic cerebral ischemia. An appeal for systematic data gathering prior to a new EC/IC trial. Stroke. 1997; 28(10): 1857–1860.
  4. Bevan JA, Joyce EH. Flow-dependent contraction observed in a myograph-mounted resistance artery. Blood Vessels. 1988; 25(5): 261–264.
  5. Bevan JA, Joyce EH. Saline infusion into lumen of resistance artery and small vein causes contraction. Am. J. Physiol. 1990; 259(1 Pt 2): H23–H28.
  6. Bokkers RPH, Wessels FJ, van der Worp HB, et al. Vasodilatory capacity of the cerebral vasculature in patients with carotid artery stenosis. AJNR Am J Neuroradiol. 2011; 32(6): 1030–1033.
  7. Frydrychowski AF, Winklewski PJ, Szarmach A, et al. Near-infrared transillumination back scattering sounding--new method to assess brain microcirculation in patients with chronic carotid artery stenosis. PLoS ONE. 2013; 8(4): e61936.
  8. Frydrychowski AF, Wszedybyl-Winklewska M, Bandurski T, et al. Flow-induced changes in pial artery compliance registered with a non-invasive method in rabbits. Microvasc. Res. 2011; 82(2): 156–162.
  9. Garcia-Roldan JL, Bevan JA. Augmentation of endothelium-independent flow constriction in pial arteries at high intravascular pressures. Hypertension. 1991; 17(6 Pt 2): 870–874.
  10. Hartkamp NS, Hendrikse J, van der Worp HB, et al. Time course of vascular reactivity using repeated phase-contrast MR angiography in patients with carotid artery stenosis. Stroke. 2012; 43(2): 553–556.
  11. Kamouchi M, Kishikawa K, Okada Y, et al. Poststenotic flow and intracranial hemodynamics in patients with carotid stenosis: transoral carotid ultrasonography study. AJNR Am J Neuroradiol. 2005; 26(1): 76–81.
  12. Mattioni A, Cenciarelli S, Biessels G, et al. Prevalence of intracranial large artery stenosis and occlusion in patients with acute ischaemic stroke or TIA. Neurol. Sci. 2014; 35(3): 349–355.
  13. Murakami M, Yonehara T, Takaki A, et al. Evaluation of delayed appearance of acetazolamide effect in patients with chronic cerebrovascular ischemic disease: feasibility and usefulness of SPECT method using triple injection of ECD. J Nucl Med. 2002; 43(5): 577–583.
  14. Razavi A, Shirani E, Sadeghi MR. Numerical simulation of blood pulsatile flow in a stenosed carotid artery using different rheological models. J Biomech. 2011; 44(11): 2021–2030.
  15. Rothwell PM, Eliasziw M, Gutnikov SA, et al. Carotid Endarterectomy Trialists' Collaboration. Analysis of pooled data from the randomised controlled trials of endarterectomy for symptomatic carotid stenosis. Lancet. 2003; 361(9352): 107–116.
  16. Sato K, Sadamoto T, Hirasawa Ai, et al. Differential blood flow responses to CO₂ in human internal and external carotid and vertebral arteries. J. Physiol. (Lond.). 2012; 590(14): 3277–3290.
  17. Skow RJ, MacKay CM, Tymko MM, et al. Differential cerebrovascular CO₂ reactivity in anterior and posterior cerebral circulations. Respir Physiol Neurobiol. 2013; 189(1): 76–86.
  18. Tong E, Wintermark M. CTA-enhanced perfusion CT: an original method to perform ultra-low-dose CTA-enhanced perfusion CT. Neuroradiology. 2014; 56(11): 955–964.
  19. Vorstrup S, Henriksen L, Paulson OB. Effect of acetazolamide on cerebral blood flow and cerebral metabolic rate for oxygen. J. Clin. Invest. 1984; 74(5): 1634–1639.
  20. 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(6): 1291–1298.
  21. Waaijer A, van Leeuwen MS, van Osch MJP, et al. Changes in cerebral perfusion after revascularization of symptomatic carotid artery stenosis: CT measurement. Radiology. 2007; 245(2): 541–548.

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