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The Effect of Hemodynamically Significant Carotid Artery Disease on the Hemodynamic Status of the Cerebral Circulation

WILLIAM J. POWERS, M.D.; GARY A. PRESS, M.D.; ROBERT L. GRUBB Jr., M.D.; MOKHTAR GADO, M.D.; and MARCUS E. RAICHLE, M.D.
[+] Article and Author Information

Grant support: by grants NS06833, AG03991, and HL13851, and by Teacher Investigator Development Award NS00647 (Dr. Powers) from the National Institutes of Health.

▸Requests for reprints should be addressed to William J. Powers, M.D.; Department of Neurology, Room 2129, The Jewish Hospital of St. Louis, 216 South Kingshighway Boulevard, P.O. Box 14109; St. Louis, MO 63178.


St. Louis, Missouri


© 1987 American College of PhysiciansAmerican College of Physicians


Ann Intern Med. 1987;106(1):27-35. doi:10.7326/0003-4819-106-1-27
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Although the presence of a hemodynamically significant carotid artery lesion is commonly used as an indicator of impaired cerebral circulation, the effect of such lesions on cerebral perfusion pressure and cerebral blood flow has never been determined accurately. We used positron emission tomography (PET) to study 19 patients with unilateral hemodynamically significant carotid artery disease ( > 66% diameter reduction) and no evidence of cerebral infarction. According to PET measurements in the cerebral hemisphere distal to the lesion, 7 patients had normal cerebral hemodynamics, 8 had reduced perfusion pressure with normal blood flow, and 4 had reduced blood flow. Neither the percent stenosis nor the residual lumen diameter in the carotid artery was a reliable indicator of the hemodynamic status of the cerebral circulation. However, a significant relationship was found between the PET measurements of cerebral hemodynamics and the arteriographic circulation pattern (p = 0.006). The role of hemodynamic factors in the pathogenesis and treatment of cerebrovascular disease cannot be determined from the severity of carotid artery disease alone.

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