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

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Abstract

Objectives

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.

Methods

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.

Results

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 < 0.01).

Conclusions

Our results suggest that subclavian steal is a benign condition in asymptomatic patients. On the other hand, arm exercise-induced rCBF reduction can occur in the cerebrum and cerebellum in patients with VBI symptoms possibly related to low CVR.

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Authors and Affiliations

  1. Department of Clinical Radiology, Graduate School of Medical Sciences, Kyushu University, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan

    Koichiro Kaneko, Takashi Yoshiura, Hirofumi Koga, Koichiro Abe, Hirofumi Sawamoto & Hiroshi Honda

  2. Cerebrovascular Center and Clinical Research Institute, National Kyushu Medical Center, Fukuoka, Japan

    Shigeru Fujimoto, Yasushi Okada, Kotaro Yasumori & Toru Muranaka

  3. Department of Health Sciences, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan

    Masayuki Sasaki

Authors
  1. Koichiro Kaneko
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  2. Shigeru Fujimoto
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  3. Yasushi Okada
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  4. Takashi Yoshiura
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  5. Kotaro Yasumori
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  6. Toru Muranaka
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  7. Masayuki Sasaki
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  8. Hirofumi Koga
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  9. Koichiro Abe
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  10. Hirofumi Sawamoto
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  11. Hiroshi Honda
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Correspondence to Koichiro Kaneko.

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Kaneko, K., Fujimoto, S., Okada, Y. et al. SPECT evaluation of cerebral blood flow during arm exercise in patients with subclavian steal. Ann Nucl Med 21, 463–470 (2007). https://doi.org/10.1007/s12149-007-0054-7

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  • DOI: https://doi.org/10.1007/s12149-007-0054-7

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