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Robertus H. C. Bisschops, MD; Catharina J. M. Klijn, MD, PhD; L. Jaap Kappelle, MD, PhD; Alexander C. van Huffelen, MD, PhD; Jeroen van der Grond, PhD

Arch Neurol. 2003;60:229-233.

Context  Ischemic lesions in patients with internal carotid artery (ICA) steno-occlusive disease can be categorized on the basis of their location and presumed cause: external border zone infarcts, internal border zone infarcts, cortical infarcts, lacunar infarcts, and periventricular lesions.

Objective  To evaluate the association between the prevalence and size of ischemic lesions and cerebral vasomotor reactivity in patients with unilateral occlusion of the ICA.

Design  Cross-sectional study.

Setting  Referral center.

Patients  Seventy consecutive patients were included in this study. All patients had a transient or minor disabling retinal or cerebral ischemia that was associated with unilateral occlusion of the ICA. Ischemic lesions on magnetic resonance imaging were identified on hard copies, and volume measurements were obtained by a magnetic resonance workstation. Vasomotor reactivity was assessed with transcranial Doppler ultrasonography with carbon dioxide challenge.

Main Outcome Measures  Prevalence and size of ischemic lesions.

Results  In the hemisphere ipsilateral to the ICA occlusion, we found an increased prevalence of internal border zone infarcts (P = .01), external borders zone infarcts (P<.001), and territorial infarcts (P = .02) compared with the contralateral hemisphere. Hemispheres with a carbon dioxide reactivity less than or equal to 18% demonstrated a significant increase in prevalence (P = .007) and volume (P = .003) of internal border zone infarcts compared with hemispheres with a carbon dioxide reactivity greater than or equal to 19%. No association between carbon dioxide reactivity and any other type of ischemic lesion was found.

Conclusion  In patients with an ICA occlusion, only internal border zone infarcts demonstrate a significant association with diminished cerebral hemodynamics.

From the Departments of Radiology (Drs Bisschops and van der Grond), Neurology (Drs Klijn and Kappelle), and Clinical Neurophysiology (Dr van Huffelen), University Medical Center–Utrecht, Utrecht, the Netherlands.

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