SPECT evaluation of cerebral blood flow during arm exercise in patients with subclavian steal

To explore the cerebral hemodynamics in subclavian steal syndrome, we examined the cerebral perfusion of seven patients with subclavian steal (one symptomatic and six asymptomatic) using single-photon emission computed tomography (SPECT) during resting, arm exercise, and acetazolamide-activated cond...

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Bibliographic Details
Published in:Annals of nuclear medicine 2007-10, Vol.21 (8), p.463-470
Main Authors: Kaneko, Koichiro, Fujimoto, Shigeru, Okada, Yasushi, Yoshiura, Takashi, Yasumori, Kotaro, Muranaka, Toru, Sasaki, Masayuki, Koga, Hirofumi, Abe, Koichiro, Sawamoto, Hirofumi, Honda, Hiroshi
Format: Article
Language:English
Subjects:
Aged
Brain - blood supply
Brain - diagnostic imaging
Brain - physiopathology
Cerebrovascular Circulation
Exercise Test
Female
Humans
Male
Middle Aged
Subclavian Steal Syndrome - diagnostic imaging
Subclavian Steal Syndrome - physiopathology
Tomography, Emission-Computed, Single-Photon - methods
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Summary:To explore the cerebral hemodynamics in subclavian steal syndrome, we examined the cerebral perfusion of seven patients with subclavian steal (one symptomatic and six asymptomatic) using single-photon emission computed tomography (SPECT) during resting, arm exercise, and acetazolamide-activated conditions. The regional CBF (rCBF) was measured with SPECT under all conditions, and region of interest (ROI) analysis was performed using a three-dimensional stereotaxic ROI template (3DSRT). We evaluated the relationship between arm exercise-induced rCBF change and (1) presence of subclavian artery stenosis, (2) vertebral reverse flow severity, (3) presence of vertebro-basilar insufficiency (VBI) symptoms, and (4) cerebrovascular reactivity (CVR) to acetazolamide. Overall, no arm exercise-induced rCBF reduction was observed on either the affected or the unaffected side, even in patients with severe vertebral reverse flow. One patient with VBI symptoms showed an arm exercise-induced global rCBF reduction in the cerebrum and cerebellum, whereas the other asymptomatic patients did not. The %rCBF changes in segments with severely impaired CVR (-8.6%+/-10.7%, mean+/-SD) were significantly lower than those in other segments with less impaired CVR (P
ISSN:0914-7187
1864-6433
DOI:10.1007/s12149-007-0054-7