Abstract

This project will prospectively investigate the role of cerebral hemodynamic factors in the pathogenesis of stroke in patients with symptomatic carotid artery occlusion using positron emission tomography (PET). Patients who do not anticipate cerebrovascular surgery will undergo PET studies and then be followed to determine if the subsequent occurrence of stroke is related to the PET measurements. The primary objective of this project is to test the hypothesis that increased oxygen extraction in the cerebral hemisphere distal to symptomatic carotid artery occlusion is an independent predictor of the subsequent risk of stroke in medically treated patients. The secondary objectives are (1) to determine other predictive factors for stroke in this population, and (2) to determine the temporal evolution of cerebral hemodynamic abnormalities measured by PET. These objectives will be accomplished by the use of positron emitting radiotracers to measure regional cerebral blood flow (rCBF), regional cerebral blood volume (rCBV), and regional cerebral oxygen extraction fraction (rOEF) in patients with symptomatic internal carotid artery occlusion. Information on potential epidemiologic, clinical and angiographic risk factors will be collected at the time of PET. Patients will be followed to determine the subsequent occurrence of stroke. We will then do multivariate analysis to determine the independent predictors for stroke in this sample. A subgroup (25% of patients) will be brought back for yearly repeat PET scans to determine the temporal evolution of the PET findings.

  Funding Agency

Agency
National Institute of Health (NIH)
Institute
National Institute of Neurological Disorders and Stroke (NINDS)
Type
Research Project (R01)
Project #
5R01NS028947-02
Application #
3415670
Study Section
Neurology A Study Section (NEUA)
Project Start
1991-12-15
Project End
1996-11-30
Budget Start
1992-12-01
Budget End
1993-11-30
Support Year
2
Fiscal Year
1993
Total Cost
Indirect Cost

  Institution

Name
Washington University
Department
Type
Schools of Medicine
DUNS #
062761671
City
Saint Louis
State
MO
Country
United States
Zip Code
63130

  Publications

Powers, William J (2014) William M. Feinberg award for excellence in clinical stroke: hemodynamics and stroke risk in carotid artery occlusion. Stroke 45:3123-8
Powers, William J (2012) Letter by Powers Regarding Article, ""Failure of cerebral hemodynamic selection in general or of specific positron emission tomography methodology? Carotid occlusion surgery study (COSS)"". Stroke 43:e43
Jiang, Thomas T; Videen, Tom O; Grubb Jr, Robert L et al. (2010) Cerebellum as the normal reference for the detection of increased cerebral oxygen extraction. J Cereb Blood Flow Metab 30:1767-76
Derdeyn, Colin P; Carpenter, David A; Videen, Tom O et al. (2007) Patterns of infarction in hemodynamic failure. Cerebrovasc Dis 24:11-9
Derdeyn, Colin P; Cross 3rd, DeWitte T; Moran, Christopher J et al. (2002) Postprocedure ischemic events after treatment of intracranial aneurysms with Guglielmi detachable coils. J Neurosurg 96:837-43
Derdeyn, Colin P; Videen, Tom O; Yundt, Kent D et al. (2002) Variability of cerebral blood volume and oxygen extraction: stages of cerebral haemodynamic impairment revisited. Brain 125:595-607
Derdeyn, C P; Grubb Jr, R L; Powers, W J (2001) PET screening of carotid occlusion. Adm Radiol J 20:20-5
Derdeyn, C P; Videen, T O; Grubb Jr, R L et al. (2001) Comparison of PET oxygen extraction fraction methods for the prediction of stroke risk. J Nucl Med 42:1195-7
Derdeyn, C P; Khosla, A; Videen, T O et al. (2001) Severe hemodynamic impairment and border zone--region infarction. Radiology 220:195-201
Derdeyn, C P; Simmons, N R; Videen, T O et al. (2000) Absence of selective deep white matter ischemia in chronic carotid disease: a positron emission tomographic study of regional oxygen extraction. AJNR Am J Neuroradiol 21:631-8

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