Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature

Settakis, Georgios; Molnár, Csilla; Kerényi, Levente; Kollár, Ján; Legemate, Dink A.; Csiba, László; Fülesdi, Béla

doi:10.1046/j.1468-1331.2003.00675.x

Cited by 96 publications

(105 citation statements)

References 130 publications

(234 reference statements)

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“…In fact, recent studies have shown that the CVR is a reliable predictor of subsequent ischemic stroke; thus, an evaluation of the CVR should be important for considering the therapeutic strategy for ischemic disease, including surgical intervention. 19 Indeed, in Moyamoya disease, the CVR is usually measured to determine whether revascularization surgery is necessary and which cerebral hemisphere should undergo surgery initially. 8,20,21 However, any measurement of CVR requires 2 SPECT evaluations, including resting and ACZ activation studies, which may be burdensome to patients, and ACZ activation may cause side effects such as headache and a feeling of discomfort.…”

Section: Discussionmentioning

confidence: 99%

“…8,20,21 However, any measurement of CVR requires 2 SPECT evaluations, including resting and ACZ activation studies, which may be burdensome to patients, and ACZ activation may cause side effects such as headache and a feeling of discomfort. 19,22 Especially in patients with a very severe decrease in CVR, the administration of ACZ sometimes causes a further reduction in CBF due to the vascular steal phenomenon to the adjacent area with relatively preserved CVR. 19,22 Therefore, ACZ should be administered cautiously in patients with severe ischemic symptoms.…”

Section: Discussionmentioning

confidence: 99%

“…19,22 Especially in patients with a very severe decrease in CVR, the administration of ACZ sometimes causes a further reduction in CBF due to the vascular steal phenomenon to the adjacent area with relatively preserved CVR. 19,22 Therefore, ACZ should be administered cautiously in patients with severe ischemic symptoms. Indeed, in 5 of the 30 patients in our study, ACZ activation was not performed for fear of worsening their ischemic symptoms via the steal phenomenon.…”

Section: Discussionmentioning

confidence: 99%

See 2 more Smart Citations

The Leptomeningeal “Ivy Sign” on Fluid-Attenuated Inversion Recovery MR Imaging in Moyamoya Disease: A Sign of Decreased Cerebral Vascular Reserve?

Mori¹,

Mugikura²,

Higano³

et al. 2009

AJNR Am J Neuroradiol

107

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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The Leptomeningeal “Ivy Sign” on Fluid-Attenuated Inversion Recovery MR Imaging in Moyamoya Disease: A Sign of Decreased Cerebral Vascular Reserve?

Mori¹,

Mugikura²,

Higano³

et al. 2009

AJNR Am J Neuroradiol

107

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“…AZ inhibits the activity of carbonic anhydrase, which reversibly catalyses the formation of H 2 CO 3 from CO 2 + H 2 O. It increases the concentrations of H + and CO 2 , which is assumed to be the stimuli for the increase in flow; however, the exact mechanism is yet to be determined (Settakis et al, 2003).…”

Section: Independent Regulation Of Neurovascular Coupling and Acetazomentioning

confidence: 99%

Acetazolamide-Induced Vasodilation Does Not Inhibit the Visually Evoked Flow Response

Yonai

Boms

Molnár

et al. 2009

J Cereb Blood Flow Metab

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Different methods are used to assess the vasodilator ability of cerebral blood vessels; however, the exact mechanism of cerebral vasodilation, induced by different stimuli, is not entirely known. Our aim was to investigate whether the potent vasodilator agent, acetazolamide (AZ), inhibits the neurovascular coupling, which also requires vasodilation. Therefore, visually evoked flow parameters were examined by transcranial Doppler in ten healthy subjects before and after AZ administration. Pulsatility index and peak systolic flow velocity changes, evoked by visual stimulus, were recorded in the posterior cerebral arteries before and after intravenous administration of 15 mg/kg AZ. Repeated-measures ANOVA did not show significant group main effect between the visually evoked relative flow velocity time courses before and after AZ provocation (P = 0.43). Visual stimulation induced significant increase of relative flow velocity and decrease of pulsatility index not only before but also at the maximal effect of AZ. These results suggest that maximal cerebral vasodilation cannot be determined by the clinically accepted dose of AZ (15 mg/kg) and prove that neurovascular coupling remains preserved despite AZ-induced vasodilation. Our observation indicates independent regulation of vasodilation during neurovascular coupling, allowing the adaptation of cerebral blood flow according to neuronal activity even if other processes require significant vasodilation.

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“…The SPECT study was started after 60 min. For the stimulation study, the radiopharmaceutical was injected 15 min after acetazolamide (15 mg of diamox per kilogram; Lederle Laboratories) because earlier studies showed maximal vasodilation at this time (13).…”

Section: Methodsmentioning

confidence: 99%

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

Káplár¹,

Paragh²,

Erdei³

et al. 2009

J Nucl Med

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Although macrovascular complications are typical for type 2 diabetes mellitus (T2DM), cerebral microvascular damage develops both in type 1 diabetes mellitus (T1DM) and T2DM. Color Doppler ultrasound is widely used for the examination of large-and medium-sized arteries, whereas SPECT and MRI are capable of identifying disturbances in the circulation of microvessels. Former studies using semiquantitative methods showed reduced reactivity and reserve capacity of cerebral vessels in both T1DM and T2DM patients. Our aim was to investigate whether there was any difference in the effects of the 2 types of diabetes mellitus on the global or regional cerebral blood flow, influenced by microvascular damage. Methods: In our study, the circulation and reserve capacity of cerebral arteries was examined using 99m Tc-hexamethylpropylene amine oxime SPECT. A total of 17 individuals with T1DM and 43 individuals with T2DM were involved in the study. Results: Both basal and acetazolamide-challenged brain circulation were significantly lower in T2DM patients than in T1DM patients. We did not find a significant difference in the reserve capacity. However, the circulation of the frontal and occipital lobes changed differently in the 2 groups. The ratio of the circulation of the frontal and occipital lobes was significantly reduced both in basal and in acetazolamide-stimulated states in T2DM patients, independently of age (P , 0.0005 and P , 0.017), showing a greater relative decrease in the circulation of the frontal lobe in T2DM patients. Conclusion: There was a significant association between basal brain circulation and age, body mass index, and high-density lipoprotein (HDL), whereas acetazolamide-stimulated circulation showed a significant association with serum triglyceride and HDL.Key Words: diabetes mellitus; cerebral perfusion; SPECT; reserve capacity; frontooccipital ratio Nucl Med 2009; 50:1993 50: -1998 50: DOI: 10.2967 Di abetes mellitus considerably increases the risk of stroke due to the damage of cerebral arteries (1,2). Macrovascular complications are typical for type 2 diabetes mellitus (T2DM); however, the injury of cerebral microvessels can be detected in both type 1 diabetes mellitus (T1DM) and T2DM. Hyperglycemia leads to structural damage of capillaries and endothelial dysfunction, and the permeability of the blood-brain barrier is also altered in diabetics (3). These factors significantly affect the regional and global cerebral blood flow (CBF) and the metabolism of the brain. The damage of the vessels can be demonstrated even before the appearance of clinical symptoms. B-mode ultrasound can be useful in the examination of large and medium arteries, whereas SPECT, MRI, and transcranial Doppler are able to recognize disturbances of the microcirculation. Previous studies using Doppler ultrasound found decreased reactivity and reserve capacity of large and medium arteries in both types of diabetes (4-6). Fülesdi et al. found that the decrease in circulation became pronounced 10 y after the diagnosis of both typ...

show abstract

Acetazolamide as a vasodilatory stimulus in cerebrovascular diseases and in conditions affecting the cerebral vasculature

Cited by 96 publications

References 130 publications

The Leptomeningeal “Ivy Sign” on Fluid-Attenuated Inversion Recovery MR Imaging in Moyamoya Disease: A Sign of Decreased Cerebral Vascular Reserve?

The Leptomeningeal “Ivy Sign” on Fluid-Attenuated Inversion Recovery MR Imaging in Moyamoya Disease: A Sign of Decreased Cerebral Vascular Reserve?

Acetazolamide-Induced Vasodilation Does Not Inhibit the Visually Evoked Flow Response

Changes in Cerebral Blood Flow Detected by SPECT in Type 1 and Type 2 Diabetic Patients

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