This paper is only available as a PDF. To read, Please Download here.
Purpose. The objective of this study was to elucidate the effect of intravenous administration
of nicardipine on the cerebral blood flow of hypertensive patients with internal carotid
artery occlusion (ICAO). Patients and Methods. Six patients with ICAO and 10 normal individuals were examined by positron emission
tomography. The cerebral blood flow (CBF), cerebral blood volume (CBV), cerebral metabolic
rate of oxygen, oxygen extraction fraction (OEF) and CBF/CBV ratio were evaluated
for each vascular territory and each hemisphere, and the interhemispheric asymmetry
index of each parameter was also calculated. Nicardipine was administered intravenously
to each patient, and the changes in CBF (ΔCBF%) and in blood pressure (ΔBP) were examined.
Results. After the administration of nicardipine, the CBF was significantly increased in
the patient hemisphere and was unchanged in the occluded hemisphere. Stepwise regression
analysis disclosed that the ΔBP and asymmetry index of OEF were significantly correlated
with the ΔCBF% in the occluded hemisphere. Conclusions. These results suggest that CBF is unchanged or increased in ICAO patients after
nicardipine administration, but that excessive reduction of blood pressure may lead
to CBF decrease in the patients with marked hemodynamic imbalance between the occluded
and patent hemispheres. These results suggest that it is advisable not to reduce blood
pressure excessively in these patients in the treatment of perioperative or acute
hypertension with calcium antagonist.
Key words
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Journal of Stroke and Cerebrovascular DiseasesAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Carotid endarterectomy in the octogenarian.Ann Vasc Surg. 1994; 8: 417-420
- Intracranial internal carotid artery stenosis.Stroke. 1982; 13: 825-828
- Efficacy and safety of intravenous nicardipine in the control of postoperative hypertension.Chest. 1991; 99: 393-398
- Nicardipine: A review of its pharmacodynamics and pharmacokinetic properties, and its therapeutic efficacy, in the treatment of angina pectoris, hypertension and related cardiovascular disorders.Drugs. 1987; 33: 296-345
- Intravenous nicardipine for the treatment of severe hypertension. A double-blind, placebo-controlled multicenter trial.Arch Intern Med. 1989; 149: 2662-2669
- Vasodilator profile of a new 1,4-dihydropyridine derivative, 2,6-dimethyl-4-(3-nirtophenyl)-1,4-dihydropyridine-3,5-dicarboxylic acid 3-[2-(N-benzyl-N-methylamino)]-ethyl ester 5-methyl ester hydrochloride (YC-93).Arzneimittelforschung. 1976; 26: 2172-2178
- Effects of dihydropyridines on cerebral blood vessels.J Hypertens. 1993; 11: S9-S12
- Effects of nicardipine on cerebral vascular responses to hypocapnia and blood flow velocity in the middle cerebral artery.Stroke. 1991; 22: 1170-1172
- Cerebrovascular effects of YC-93, a new vasodilator, in dogs, monkeys and human patients.J Clin Pharmacol. 1979; 17: 1-11
- Time dependency of the acetazolamide effect on cerebral hemodynamics in patients with chronic occlusive cerebral arteries; early steal phenomenon demonstrated by [15O]H2O positron emission tomography.Stroke. 1995; 26: 1825-1829
- Evaluation of the cerebral vasodilatory capacity by the acetazolamide test before EC-IC bypass surgery in patients with occlusion of the internal carotid artery.Stroke. 1986; 17: 1291-1298
- The fifth report of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure (JNC-V).Arch Intern Med. 1993; 153: 154-183
- PET and the autoradiographic method with continuous inhalation of oxygen-15-gas: theoretical analysis and comparison with conventional steady-state methods.J Nucl Med. 1993; 34: 1672-1680
- Quantitative measurement of regional cerebral blood flow and oxygen metabolism in man using 15O and positron emission tomography: theory, procedure and normal values.J Comput Assist Tomogr. 1980; 4: 727-736
- Correction for the presence of intravascular oxygen-15 in the steady-state technique for measuring regional oxygen extraction ratio in the brain: 1. Description of the method.J Cereb Blood Flow Metab. 1983; 3: 416-424
- Hemodynamics in internal carotid artery occlusion examined by positron emission tomography.Stroke. 1990; 21: 1400-1406
- Neuroanatomy and cranial computed tomography.in: Thieme, New York1986: 70-74
- Cerebral hemodyhamics in ischemic cerebrovascular disease.Ann Neurol. 1991; 29: 231-240
- Mechanisms of relaxant action of nicardipine, a new Ca-antagonist, on isolated dog cerebral and mesenteric arteries.Stroke. 1983; 14: 270-275
- Effects of nicardipine and nifedipine on cerebral circulation in CVD.J Cereb Blood Flow Metab. 1983; 3: S560
- Nicardipine improves cerebral hemodynamics in acute and subacute stroke.Neurology. 1992; 42: 251
- The effect of hemodynamically significant carotid artery disease on the hemodynamic status of the cerebral circulation.Ann Intern Med. 1987; 106: 27-35
- Correlation of xenon-enhanced computed tomography-defined cerebral blood flow reactivity and collateral flow patterns.Stroke. 1994; 25: 1784-1787
- rCBF in patients with carotid occlusion. Resting and hypercapnic flow related to collateral pattern.Stroke. 1982; 13: 155-162
- Crossed cerebellar hypoperfusion indicates the degree of uncoupling between blood flow and metabolism in major cerebral arterial occlusion.Stroke. 1994; 25: 1945-1951
Article info
Publication history
Accepted:
February 14,
1997
Received:
November 6,
1996
Identification
Copyright
© 1997 National Stroke Division. Published by Elsevier Inc.
