Long-term prognosis of medically treated patients with internal carotid ormiddle cerebral artery occlusion - Can acetazolamide test predict it?

Background and Purpose-The importance of hemodynamic parameters for predict ing outcome in patients with occlusive carotid disease remains controversia l. The present study was aimed at testing the hypothesis that regional cere brovascular reactivity (rCVR) to acetazolamide can be a reliable predictor of subsequent ischemic stroke in medically treated patients with internal c arotid artery or middle cerebral artery occlusion. Methods-Seventy-seven symptomatic patients were enrolled in this prospectiv e, longitudinal cohort study. All patients met inclusion criteria of cerebr al angiography, no or localized cerebral infarction on MRI or CT, and no or minimal neurological deficit. Regional cerebral blood flow (rCBF) and rCVR to acetazolamide were quantitatively determined by Xe-133 SEPCT. All patie nts were categorized into 4 types on the basis of SPECT studies. Results-During an average follow-up period of 42.7 months, 16 total and 7 i psilateral ischemic strokes occurred. The annual risks of total and ipsilat eral stroke in patients with decreased rCBF and rCVR were 35.6% and 23.7%, respectively, risks that are higher than those in other types of patients. When strokes were categorized into patients with and without decreased rCBF and rCVR, Kaplan-Meier analysis revealed that the risks of total and ipsil ateral stroke in patients with decreased rCBF and rCVR were significantly h igher than in those without (P < 0.0001 and P = 0.0001, respectively, log-r ank test). Relative risk conferred by decreased rCBF and rCVR was 8.0 (95% Cl, 1.9 to 34.4) for ipsilateral stroke and 3.6 (95% CI, 1.4 to 9.3) for to tal stroke. Conclusions-Decreased rCBF and rCVR to acetazolamide may identify a subgrou p of patients who have a higher risk of subsequent ischemic stroke when tre ated medically.