Identification of hemodynamic compromise by cerebrovascular reserve and oxygen extraction fraction in occlusive vascular disease

Edwin M. Nemoto, Howard Yonas, Hiroto Kuwabara, Ronda R. Pindzola, Donald Sashin, Carolyn C. Meltzer, Julie C. Price, Yuefang Chang, David W. Johnson

Research output: Contribution to journalArticle


Cerebrovascular reserve (CVR) and oxygen extraction fraction (OEF) are used to identify hemodynamic compromise in symptomatic patients with carotid occlusive vascular disease, but evidence suggests that they are not equivalent. The authors studied the relationship between CVR and OEF to evaluate their equivalence and stages of hemodynamic compromise. Symptomatic patients (N = 12) with carotid occlusion were studied by stable xenon-computed tomography CBF after intravenous acetazolamide administration for CVR, followed within 24 hours by positron emission tomography (PET) for OEF. Middle cerebral artery territories were analyzed by hemisphere and level. Hemispheric subcortical white matter infarctions were graded with magnetic resonance imaging. Both hemispheric and level analysis of CVR and OEF showed a significant (P = 0.001), negative linear relationship [CVR (%) = -1.5 (OEF) + 83.4, (r = -0.57, P = 0.001, n:= 24]. However, 37.5% of the hemispheres showed compromised CVR but normal OEF and were associated (P = 0.019) with subcortical white matter infarction. CMRO2 was elevated in stage II hemodynamic compromise (CVR < 10%, OEF > 50%). CVR and OEF showed a significant negative linear relationship in stage II hemodynamic compromise but revealed hemispheres in hemodynamic compromise by CVR but normal OEF that were associated with subcortical white matter infarction.

Original languageEnglish (US)
Pages (from-to)1081-1089
Number of pages9
JournalJournal of Cerebral Blood Flow and Metabolism
Issue number10
StatePublished - Oct 1 2004
Externally publishedYes



  • Acetazolamide
  • Carotid artery occlusion
  • Cerebrovascular reserve
  • Focal cerebral ischemia
  • Oxygen extraction fraction
  • Positron emission tomography

ASJC Scopus subject areas

  • Neurology
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

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