Chronic Middle Cerebral Artery Occlusion: A Hemodynamic and Metabolic Study with Positron-Emission Tomography

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Fig 1.
Locations of regions of interest: cortical territories of the ACA, MCA, PCA, and the corona radiata. The watershed areas between the ACA and MCA (AWS) and the watershed areas between the MCA and PCA (PWS) were excluded from the analysis.
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Fig 2.
Angiographic assessment of the patients. This diagram shows schematic representations of the circle of Willis and the major intracranial vessels in each patient. Black lesions indicate the location of the stenosis or occlusion. Acom indicates the anterior communicating artery; Pcom, the posterior communicating artery; Rt; right, Lt; left; M1-M3, collaterals reconstituting the M1, M2, or M3 segments; None, little or no significant reconstitution of the territory of the occluded vessel.

Table 1:

Clinical backgrounds of the 13 patients

Patient No.	Age	Sex	Presentation	Onset PET (months)	Occlusion Site	Cause of Occlusion	Site of Infarct	Infarct Size (mm)
1	46	M	No symptom		R M1 p	Unknown	L corona radiata	29
2	62	M	No symptom		L M1 p	Atherosclerotic	None
3	66	M	No symptom		L M1 p	Atherosclerotic	None
4	62	M	No symptom		L M1 p	Atherosclerotic	R corona radiata	6
5	48	M	Minor stroke	182	L M1 p	Atherosclerotic	L putamen	25
6	44	M	Minor stroke	38	L M1 p	Atherosclerotic	L putamen, corona radiata	29
7	72	M	Minor stroke	1081	L M1 p	Atherosclerotic	L frontal cortex	23
8	63	M	TIA	27	R M1 d	Atherosclerotic	R temporo-occipital cortex	22
9	39	M	TIA	238	R M1 p	Atherosclerotic	None
10	58	M	No symptom		R M1 p	Atherosclerotic	L putamen	4
11	64	F	Minor stroke	129	R M1 p	Atherosclerotic	R internal capsule, corona radiata	5
12	56	F	Minor stroke	273	R M1 p	Atherosclerotic	R corona radiata, frontal subcortex	30
13	69	F	TIA	36	R M1 p	Atherosclerotic	R frontal cortex	10

Note:—TIA indicates transient ischemic attack; L, left; R, right; p, proximal; d, distal.

Table 2:

Cerebral blood flow and metabolism in the symptomatic and asymptomatic patients

Note:—CBF indicates cerebral bloodflow; OEF, oxygen extraction fraction; CBV, cerebral blood volume; CMRO₂, cerebral metabolic rate of oxygen.

Table 3:

Background hemodynamic parameters and clinical characteristics in the normal and increased OEF groups

	Normal OEF (n = 9)	Increased OEF (n = 4)
Hemoglobin (g/dL)	13.5 ± 1.6	11.8 ± 0.5
O₂ content (mL/dL)	17.8 ± 2.5	15.6 ± 0.9
Mean blood pressure (mm Hg)	93.7 ± 10.1	89.2 ± 5.7
PaCO₂ during C¹⁵O₂ inhalation (mm Hg)	39.6 ± 2.3	40.0 ± 1.8
PaCO₂ during ¹⁵O₂ inhalation (mm Hg)	39.9 ± 2.8	40.9 ± 2.2
Age (mean ± SD) (yr)	55.8 ± 11.6	61.8 ± 5.9
Sex (male/female) (No.)^*	9/0	1/3
Symptomatic (No.)	5	3
Hypertension (No.)	6	4
Diabetes mellitus (No.)	2	0

Note:—OEF indicates oxygen extraction traction; PaCO₂, partial pressure of carbon dioxide.
* P < .05.

Table 4:

Cerebral blood flow and metabolism in the normal and increased OEF groups

Note:—CBF indicates cerebral bloodflow; OEF, oxygen extraction fraction; CBV, cerebral blood volume; CMRO₂, cerebral metabolic rate of oxygen; MCA, middle cerebral artery; ACA, anterior cerebral artery; PCA, posterior cerebral artery.
* P < .05.
† P < .01.