Characteristics of dynamic cerebral autoregulation in cerebral small vessel disease: Diffuse and sustained

Abstract

Cerebral small vessel disease is a major cause of stroke and vascular dementia; however, the pathogenesis is largely unclear. In this study, we investigated the characteristics of the impairment of dynamic cerebral autoregulation (dCA) in lacunar infarction patients. Seventy-one lacunar infarction patients were enrolled in the study, including 46 unilateral middle cerebral artery (MCA) territory stroke patients and 25 unilateral posterior cerebral artery (PCA) territory stroke patients. Each group of patients was randomly divided into two subgroups. Group 1 underwent dCA assessments in the bilateral MCAs, and Group 2 underwent dCA assessments in the bilateral PCAs. All patients were followed up for 6 months. Transfer function analysis was applied to derive the autoregulatory parameters of gain and phase difference. In the unilateral MCA territory stroke patients, impairments of dCA were observed in both the MCAs and PCAs, and the same results were observed in the unilateral PCA territory stroke patients. These impairments remained unchanged during the 6-month follow-up. In lacunar infarction, which is most prevalent type of cerebral small vessel disease, though patients with unilateral MCA territory/PCA territory stroke, the impairments of dCA were global and sustained. This finding suggests that the physiological changes associated with lacunar infarction were diffuse.

Comparing Different Recording Lengths of Dynamic Cerebral Autoregulation: 5 versus 10 Minutes

“…The stability of gain and coherence in TFA has not been tested in large scale or discussed, and it seems that in a 10-minute time scale, gain and coherence may not be stable according to Deegan's and our findings. In previous studies of dCA in stroke, gain has not been reported to differ between patients and controls [ 12 , 14 , 21 , 28 ]. If gain is an unstable dCA index, it would be difficult to correlate gain with other physiologic or clinical variables.…”

Assessment of cerebral autoregulation in stroke: A systematic review and meta-analysis of studies at rest

“…33 studies were included comprising 18 on AIS (large artery stroke, one study that also included transient ischemic attack (TIA)), 12, 13, 26-41 six on ICH, [42][43][44][45][46][47] three on small artery stroke, including lacunar infarction, [48][49][50] and six on AIS both large and small artery stroke 2, 23-25, 51, 52 .…”

“…13, 24, 27, 29, 32, 35-38, 43, 46 Moreover, the majority of participants were recruited within 6 to 72 hours from stroke onset, 2, 12, 13, 24-27, 29, 34-40, 42, 43, 45-47, 49, 51 including within 48 hours (n = 8), 2, 25, 34-36, 39, 47, 49 five studies assessed dCA at 72 hours, 24,29,40,45,51 twenty-four hours were studied in four studies, 37,42,43,46 three studies examined dCA between 30 to 37 hours, 12,13,38 dCA was assessed at 6 hours (n = 2), 26,27 one study assessed between onset to 16 days, 52 other three studies recruited participants after first week of stroke onset 32,33,48 and one study examined recovery at 6 months. 49 The location of the lesion was identified in the MCA (n = 13), 23, 26-28, 33-37, 40, 41, 49, 51 posterior cerebral artery (n = 3), 31,32,49 and anterior cerebral artery territories (n = 3), 2, 25, 52 though eight studies did not specify the precise localization of the lesion. 12,13,24,29,38,39,48,50 Five studies of ICH recruited participants for dCA testing within 48 hours of onset, 42,43,[45][46][47] with the exception of one study which assessed at 4-6 days after onset.…”

Dissociation among hemodynamic measures in asymptomatic high grade carotid artery stenosis

“…Loss of blood flow regulation occurs in a variety of cerebrovascular conditions, both in acute stroke(25-27), and in chronic cerebrovascular conditions such as small vessel disease(28, 29), metabolic syndrome(30, 31), and high grade carotid artery stenosis(32-34). Poor blood flow is an important predictor of stroke risk.…”