Compromised cerebral blood-flow reactivity is a predictor of stroke in patients with symptomatic carotid-artery occlusive disease. Webster, M., Makaroun, M., Steed, D., Smith, H., Johnson, D., & Yonas, H JOURNAL OF VASCULAR SURGERY, 21(2):338--345, February, 1995.
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Purpose: The purpose of this study was to determine whether the hemodynamic consequences of extracranial carotid disease correlate with the risk of subsequent cerebral infarction. Methods: In 95 patients with symptoms who had greater than or equal to 70% stenosis (31 patients) or who had occlusion (64 patients) of the ipsilateral carotid artery, cerebral blood how was measured by the stable xenon/computed tomography technique both at baseline and after vasodilatory challenge with intravenous acetazolamide. Patients were stratified into group 1, 43 patients with no more than a 5% decrease in flow in any vascular territory, and group 2, 52 patients with greater than a 5% decrease in one or more vascular territories after an acetazolamide challenge. Results: In group 2, 15 (28.9%) of 52 patients had a new stroke, but only one (2.3%) of 43 patients in group 1 did (p = 0.0005). Of patients with total carotid occlusion 10 (26%) of 38 in group 2 and none (0%) of 26 in group 1 had a new stroke (p = 0.003). Of patients with greater than or equal to 70% stenosis, five (36%) of 14 in group 2 and only one (6%) of 17 in group 1 had a stroke (p = 0.067). Conclusion: The loss of cerebral reactivity in patients with symptoms who had greater than or equal to 70% carotid stenosis or occlusion is an important predictor of impending cerebral infarction.
@article{webster_compromised_1995,
	title = {Compromised cerebral blood-flow reactivity is a predictor of stroke in patients with symptomatic carotid-artery occlusive disease},
	volume = {21},
	issn = {0741-5214},
	abstract = {Purpose: The purpose of this study was to determine whether the hemodynamic consequences of extracranial carotid disease correlate with the risk of subsequent cerebral infarction.

Methods: In 95 patients with symptoms who had greater than or equal to 70\% stenosis (31 patients) or who had occlusion (64 patients) of the ipsilateral carotid artery, cerebral blood how was measured by the stable xenon/computed tomography technique both at baseline and after vasodilatory challenge with intravenous acetazolamide. Patients were stratified into group 1, 43 patients with no more than a 5\% decrease in flow in any vascular territory, and group 2, 52 patients with greater than a 5\% decrease in one or more vascular territories after an acetazolamide challenge.

Results: In group 2, 15 (28.9\%) of 52 patients had a new stroke, but only one (2.3\%) of 43 patients in group 1 did (p = 0.0005). Of patients with total carotid occlusion 10 (26\%) of 38 in group 2 and none (0\%) of 26 in group 1 had a new stroke (p = 0.003). Of patients with greater than or equal to 70\% stenosis, five (36\%) of 14 in group 2 and only one (6\%) of 17 in group 1 had a stroke (p = 0.067).

Conclusion: The loss of cerebral reactivity in patients with symptoms who had greater than or equal to 70\% carotid stenosis or occlusion is an important predictor of impending cerebral infarction.},
	number = {2},
	journal = {JOURNAL OF VASCULAR SURGERY},
	author = {Webster, MW and Makaroun, MS and Steed, DL and Smith, HA and Johnson, DW and Yonas, H},
	month = feb,
	year = {1995},
	keywords = {CVR, stenosis, acetazolamide, stroke},
	pages = {338--345},
	file = {ISI Web of Knowledge [v.4.4] - Web of Science:/Users/nickb/Zotero/storage/MR83WTTF/CitedFullRecord.html:text/html;webster1995.pdf:/Users/nickb/Zotero/storage/4XSXXZMZ/webster1995.pdf:application/pdf}
}

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