Cerebral blood flow (CBF) of 21 symptomatic patients with significant carotid stenoses was studied by single photon emission computed tomography (SPECT) with technetium 99m hexamethyl-propyleneamine oxime (Tc 99m HMPAO) at rest as baseline and during cerebral vasodilation after IV administration of acetazolamide (ACZ). Seventeen patients with significant internal carotid artery stenosis who showed increased cerebral perfusion after ACZ administration over their baseline low focal and global SPECT values were selected for surgery. A similar baseline study was done in the postoperative sixth week to assess the effect of surgery on regional and hemispheric CBF. Twelve patients with significant carotid stenoses who showed cerebral reserve in SPECT studies benefited most from the operation, and 3 patients with totally occluded left carotid arteries showed less increased CBF on their occluded sides. Endarterectomy operations were done to their contralateral stenotic arteries and their improvement varied on their occluded sides with variations of the Willis Polygon.
This study showed that Tc 99m HMPAO SPECT study with ACZ-stimulated vasodilation, done following an initial baseline study, is an adequate selection criterion for carotid endarterectomy.
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