Effect of acetazolamide reactivity and long-term outcome in patients with major cerebral artery occlusive diseases

被引:75
作者
Yokota, C [1 ]
Hasegawa, Y [1 ]
Minematsu, K [1 ]
Yamaguchi, T [1 ]
机构
[1] Natl Cardiovasc Ctr, Dept Med, Cerebrovasc Div, Osaka 565, Japan
关键词
acetazolamide; hemodynamics; tomography; emission computed; vasodilation;
D O I
10.1161/01.STR.29.3.640
中图分类号
R74 [神经病学与精神病学];
学科分类号
摘要
Background and Purpose-It remains unclear whether hemodynamic insufficiency plays a major role in ischemic events. We performed a prospective follow-up study in ischemic stroke patients with occlusive large-artery diseases to determine whether stroke recurrence is related to reduced vasodilatory capacity judged with single-photon emission CT and acetazolamide (ACZ) challenge. Methods-During the period from 1987 to 1995. we examined cerebral vasodilatory capacity with single-photon emission CT and an ACZ challenge in 105 consecutive stroke patients with severe stenosis (>75% in diameter) or occlusion oftht internal carotid artery or the trunk of the middle cerebral artery who had no or minimal infarcts on CT, According to criteria reported earlier, the patients were divided into tyro groups: normal (negative ACZ, n=50) or reduced ACZ reactivity (positive ACZ, n=55). They were prospectively followed at regular intervals for a median period of 2.7 years. Results-The Kaplan-Meier analysis revealed no difference in cumulative recurrence-free survival rate between the two groups. The multivariate analysis with Cox proportional hazards model demonstrated that a high systolic blood pressure at entry into the study significantly increased stroke recurrence (coefficient=.0466: hazard ratio=1.0477: 95% confidence interval=1.0O17 to 1.0957: P=.04). whereas antihypertensive medication significantly reduced stroke recurrence (coefficient=-1.527: hazard ratio=O.217: 95% confidence interval=0.0612 to 0.771; P=.02), but no other variables including ACZ reactivity affected stroke recurrence rare. Conclusions-The present results demonstrate that reduced vasodilatory capacity does not play a major role in stroke recurrence. Antihypertensive therapy appears to reduce stroke recurrence even in patients with hemodynamically significant arterial diseases.
引用
收藏
页码:640 / 644
页数:5
相关论文
共 32 条
[1]  
[Anonymous], 1974, JAMA-J AM MED ASSOC, V229, P409
[2]  
ARMITAGE P, 1987, STATISTICAL METHODS, P429
[3]   HYPERTENSION AND CEREBRAL ATHEROSCLEROSIS [J].
BAKER, AB ;
RESCH, JA ;
LOEWENSON, RB .
CIRCULATION, 1969, 39 (05) :701-+
[5]  
Barnett HJM, 1997, STROKE, V28, P1857
[6]  
BEEVERS DG, 1973, LANCET, V1, P1407
[7]  
CARTER AB, 1970, LANCET, V1, P485
[8]  
COX DR, 1972, J R STAT SOC B, V34, P187
[9]   COLLATERAL DEVELOPMENT AFTER CAROTID-ARTERY OCCLUSION IN FISCHER 344 RATS [J].
COYLE, P ;
PANZENBECK, MJ .
STROKE, 1990, 21 (02) :316-321
[10]   CORONARY FLOW RESERVE AND THE J-CURVE RELATION BETWEEN DIASTOLIC BLOOD-PRESSURE AND MYOCARDIAL-INFARCTION [J].
CRUICKSHANK, JM .
BMJ-BRITISH MEDICAL JOURNAL, 1988, 297 (6658) :1227-1230