Abstract
BackgroundThe aim of this randomised pilot study was to investigate the haemodynamic effects measured by oxygen-15 positron emission tomography (PET) of interventional treatment consisting of either endarterectomy or endovascular treatment of stenosed cerebropetal arteries, or tapering of antihypertensive medication in comparison with standard medical treatment alone in patients with symptomatic internal carotid artery (ICA) occlusion.MethodsTwenty-three patients with symptomatic ICA occlusion underwent PET scanning at baseline and after 3 months. Twelve patients were randomised to intervention (either endarterectomy or endovascular treatment of stenosed cerebropetal arteries, or tapering of antihypertensive medication) and 11 to standard medical treatment alone. Primary outcome was a change in cerebral blood flow (CBF), cerebral blood volume (CBV) and/or oxygen extraction fraction (OEF) after 3 months measured by PET.ResultsThere were no differences in changes in CBF, CBV or OEF between the two groups. Only patients with compromised perfusion at presentation showed a borderline significant increase in CBF of 2.8 mL/min/100 mL (95% confidence interval 0.0 to 5.7) after intervention (n = 7).ConclusionThis pilot study shows that in patients with symptomatic ICA occlusion, oxygen-15 PET did not detect differences in improvement of CBF, CBV or OEF between interventional and standard treatment.
Highlights
The aim of this randomised pilot study was to investigate the haemodynamic effects measured by oxygen-15 positron emission tomography (PET) of interventional treatment consisting of either endarterectomy or endovascular treatment of stenosed cerebropetal arteries, or tapering of antihypertensive medication in comparison with standard medical treatment alone in patients with symptomatic internal carotid artery (ICA) occlusion
Exclusion criteria were (1) ICA occlusion caused by arterial dissection or radiation vasculopathy, (2) contraindications for magnetic resonance imaging (MRI) or PET and (3) absence of any of the conditions that could be treated according to the therapeutic strategy
This study shows that patients with recent symptoms of cerebral ischaemia associated with occlusion of the ICA on average have a lower cerebral blood flow (CBF) in the hemisphere ipsilateral to the occlusion than healthy subjects
Summary
The aim of this randomised pilot study was to investigate the haemodynamic effects measured by oxygen-15 positron emission tomography (PET) of interventional treatment consisting of either endarterectomy or endovascular treatment of stenosed cerebropetal arteries, or tapering of antihypertensive medication in comparison with standard medical treatment alone in patients with symptomatic internal carotid artery (ICA) occlusion. In patients with transient ischaemic attack (TIA) or minor disabling ischaemic stroke associated with an occlusion of the internal carotid artery (ICA), the risk of recurrent stroke has been reported 5% to 6% per year [1] This risk may be as high as 12% per year in case of a demonstrated compromised flow to the brain [2,3,4]. The Carotid Occlusion Surgery Study (COSS) included patients with symptomatic ICA occlusion and poor cerebral haemodynamics as demonstrated by increased OEF measured by PET and found no benefit of extracranial/intracranial (EC/IC) bypass surgery [4,6] This trial was stopped prematurely as the 2-year risk of ipsilateral stroke was between 20% and 25% in both surgical and non-surgical groups (p = .78). The proportion of patients who had a perioperative stroke (within 30 days after surgery) was 15% [4]
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