EFFECT OF ACETAZOLAMIDE REACTIVITY AND LONG-TERM OUTCOME IN PATIENTS WITH MAJOR CEREBRAL-ARTERY OCCLUSIVE DISEASES

Background and Purpose-It remains unclear whether hemodynamic insuffic iency plays a major role in ischemic events. We performed a prospectiv e follow-up study in ischemic stroke patients with occlusive large-art ery diseases to determine whether stroke recurrence is related to redu ced vasodilatory capacity judged with single-photon emission CT and ac etazolamide (ACZ) challenge. Methods-During the period from 1987 to 19 95. we examined cerebral vasodilatory capacity with single-photon emis sion CT and an ACZ challenge in 105 consecutive stroke patients with s evere stenosis (>75% in diameter) or occlusion oftht internal carotid artery or the trunk of the middle cerebral artery who had no or minima l infarcts on CT, According to criteria reported earlier, the patients were divided into tyro groups: normal (negative ACZ, n=50) or reduced ACZ reactivity (positive ACZ, n=55). They were prospectively followed at regular intervals for a median period of 2.7 years. Results-The Ka plan-Meier analysis revealed no difference in cumulative recurrence-fr ee survival rate between the two groups. The multivariate analysis wit h Cox proportional hazards model demonstrated that a high systolic blo od pressure at entry into the study significantly increased stroke rec urrence (coefficient=.0466: hazard ratio=1.0477: 95% confidence interv al=1.0O17 to 1.0957: P=.04). whereas antihypertensive medication signi ficantly reduced stroke recurrence (coefficient=-1.527: hazard ratio=O .217: 95% confidence interval=0.0612 to 0.771; P=.02), but no other va riables including ACZ reactivity affected stroke recurrence rare. Conc lusions-The present results demonstrate that reduced vasodilatory capa city does not play a major role in stroke recurrence. Antihypertensive therapy appears to reduce stroke recurrence even in patients with hem odynamically significant arterial diseases.