Recurrent Transient Ischemic Episodes after Anticoagulation or Bypass Operation

Tsuda, Yasuyuki; Kimura, Kazufumi; Yoneda, Shotaro; Hayakawa, Tõru; Etani, Hideki; Kamada, Takenobu

doi:10.1159/000116024

Cited by 5 publications

(3 citation statements)

References 9 publications

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“…The relationship of CBF and its CO2 reactivity with CMRO2 in response to hypocapnia in cerebral ischemia has not been studied up to the present time. Previously, we reported significant hemody namic changes of the CBF and CO2 reactiv ity in cerebral ischemia [11][12][13][14],…”

Section: Introductionmentioning

confidence: 89%

“…The regional CBF (rCBF) was measured by the intra-arterial xenon-133 injection method associ ated with cerebral angiography, with informed con sent of the patient obtained after full explanation of the procedures. The method of on-line data process ing system with an Anger-type gamma camera and a minicomputer has been described in detail elsewhere [11][12][13][14]. In cases with internal carotid occlusion, measurements were done from the contralateral inter nal carotid artery of the occluded hemisphere with a vertex aspect by the method previously reported [11 -14).…”

Section: Methodsmentioning

confidence: 99%

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Effect of Hypocapnia on Cerebral Oxygen Metabolism and Blood Flow in Ischemic Cerebrovascular Disorders

et al. 1987

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Effects of hypocapnia on cerebral oxygen consumption (CMRO2) and blood flow (CBF) in cerebral ischemia were studied in 19 patients. The CMRO₂ did not change significantly during hypocapnia within the whole group of patients, because 10 out of 19 cases showed a decrease (p < 0.001) and other 9 showed an increase (p < 0.01) of CMRO₂ during hypocapnia. The first 10 showed higher resting CMRO₂ (p < 0.001) and arteriovenous differences of oxygen content (AVDO₂; p < 0.02) than the other 9 However, the resting CBF and CO₂ reactivity to hypocapnia were not different between them, and clinical situations were also similar. A dissociation between flow and metabolism was suggested in the first 10 with rather preserved CMRO₂, while reduced metabolic demands were suggested in the other 9. Different responses of CMRO₂ to hypocapnia are expected in cerebral ischemia, i.e. in cases with rather preserved CMRO₂ it decreases despite an AVDO₂ increase, suggesting a capability of CMRO2 to respond to CBF reduction, while it increases in cases with more decreased CMRO₂, as the AVDO₂ increase exceeds the CBF reduction to maintain the decreased CMRO₂ for a further CBF reduction. The vascular CO₂ reactivity, therefore, might be maintained to be constant between these patients.

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Section: Introductionmentioning

confidence: 89%

Section: Methodsmentioning

confidence: 99%

Effect of Hypocapnia on Cerebral Oxygen Metabolism and Blood Flow in Ischemic Cerebrovascular Disorders

et al. 1987

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“…The fact that a treatment designed to increase blood flow was used in patients who may have been having embolic cerebral ischemia was an oversight [16].…”

Section: Controversy Regarding the Ec-ic Bypass Trialmentioning

confidence: 99%

EC-IC bypass: The failure of a clinical trial? Applicability to PFO closure trials

Futrell

2007

Curr Treat Options Cardio Med

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Extracranial-to-intracranial (EC-IC) bypass surgery was used to prevent stroke in patients with carotid occlusion and inadequate collateral flow. Because of inappropriate proliferation of EC-IC bypass, a randomized clinical trial was carried out. The failure of the trial may have been related to inappropriate patient selection and all eligible patients not being randomized. Subsequent study has identified criteria for patient selection and new trials are underway. The present patent foramen ovale closure trials share many of the same difficulties, including overuse of the procedure and interventionalists reluctant to randomize patients. If these trials are not properly done we will be in the same situation in 20 years that the EC-IC trialists are facing today. Improvements in patient selection criteria, randomization of all eligible patients, and better statistical parameters will increase the likelihood of future trials getting the correct answer the first time. The importance of carefully done observational trials should not be overlooked.

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Cortical blood flow and cognition after extracranial-intracranial bypass in a patient with severe carotid occlusive lesions

et al. 1994

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The long-term effect of extra-intracranial arterial bypass on cerebral circulation was examined. Cortical blood flow and cognitive ability were evaluated pre- and up to 3 years post-bypass in a 58-years-old man with severe carotid occlusive lesions, who presented with 3 transient cerebral ischaemic attacks which resulted in mental deterioration over 3 years. Regional cerebral blood flow (rCBF) was evaluated pre- and up to 33 months post-bypass by 123Iodine N-isopropyl-p-iodoamphetamine (IMP) single-photon emission CT (SPECT). Mental abilities were evaluated before and up to 33 months after surgery by the Hasegawa's dementia rating scale (HDRS). Pre-operatively, cerebral angiography showed left carotid siphon occlusion and hypoplastic stenosis of left anterior cerebral artery with collaterals from the anterior communicating artery. CT and MRI showed left temporo-parietal borderzone infarction and an enhanced T 1 lesion by gadolinium-DTPA at left periventriculum. rCBF showed extensive hypoperfusion in left anterior-parieto-temporal-cortex. HDRS scores deteriorated apparently on days 3, 5, which recovered gradually on days 8, 10, 75 after onset of mental deterioration. A bypass was performed 4 months after onset. rCBF showed gradual recovery in the left anterior-parietal cortex up to 33 months after bypass. Semiquantitative rCBF showed gradual decreases of regional asymmetry after the bypass. HDRS scores returned to their maximum up to 37 months after onset. Three-year follow-up shows improved cortical rCBF and cognition after the bypass.

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Recurrent Transient Ischemic Episodes after Anticoagulation or Bypass Operation

Cited by 5 publications

References 9 publications

Effect of Hypocapnia on Cerebral Oxygen Metabolism and Blood Flow in Ischemic Cerebrovascular Disorders

Effect of Hypocapnia on Cerebral Oxygen Metabolism and Blood Flow in Ischemic Cerebrovascular Disorders

EC-IC bypass: The failure of a clinical trial? Applicability to PFO closure trials

Cortical blood flow and cognition after extracranial-intracranial bypass in a patient with severe carotid occlusive lesions

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