Dampening of Blood-Flow Pulsatility along the Carotid Siphon: Does Form Follow Function?

Schubert, Tilman; Santini, Francesco; Stalder, Aurélien F.; Bock, Jelena; Meckel, Stephan; Bonati, Leo H.; Markl, Michael; Wetzel, Stephan G.

doi:10.3174/ajnr.a2426

Cited by 42 publications

(44 citation statements)

References 32 publications

(33 reference statements)

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“…The elastic vessel wall can react on the applied force with a distension during systole and a retraction during diastole, laminarizing downstream pulsatile flow appropriate to a Windkessel reservoir. 18,28 The results of the present study are plausible because the acquired values are consistent with low intersubject variability. The acquired values of blood velocity, PI, and RI are in good accordance with Doppler sonography measurements reported in the literature.…”

Section: Discussionsupporting

confidence: 76%

“…Here, a marked attenuation of blood flow pulsatility occurs along a short-but-curved vessel section with comparable uniformity to the Atlas slope, the carotid siphon. 18 During recent years, there has been increasing evidence about the negative impact of increased arterial flow pulsatility on the brain.…”

Section: Discussionmentioning

confidence: 99%

“…15 Newer techniques such as 4D-PC-MR imaging and 2D-PC-MR imaging with multidirectional velocity-encoding have been shown superior to 2D-PC-MR imaging with unidirectional velocity-encoding in curved vessel sections. [16][17][18][19] The aim of the present study was to evaluate blood flow characteristics along the curved vessel section of the distal vertebral artery, extending from the transverse foramen C2 to the dura mater cranial to the Atlas vertebra (Atlas slope), to evaluate the effect of a tortuous vessel geometry on blood flow pulsatility. For blood flow and velocity measurements, a 2D-PC sequence with multidirectional velocity-encoding has been applied.…”

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confidence: 99%

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Attenuation of Blood Flow Pulsatility along the Atlas Slope: A Physiologic Property of the Distal Vertebral Artery?

Schubert¹,

Pansini

Bieri³

et al. 2014

AJNR Am J Neuroradiol

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Section: Discussionsupporting

confidence: 76%

Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

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Attenuation of Blood Flow Pulsatility along the Atlas Slope: A Physiologic Property of the Distal Vertebral Artery?

Schubert¹,

Pansini

Bieri³

et al. 2014

AJNR Am J Neuroradiol

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“…Recent studies found that pulsatile flow is affected by physiological and pathological vascular geometry when investigating in a proximal-distal approach. 13,30,31 An important finding in this study was that the pulsatile flow that reaches distal arterial segments was augmented with age. Firstly, the PIs in large proximal arteries were increased in elderly (Table 2) and secondly the dampening capacity of the cerebral arteries was more efficient in the young group for all cerebral arterial segments (Table 3).…”

Section: Dampening Of Pulsatile Flow In the Cerebral Arteriesmentioning

confidence: 70%

Aging alters the dampening of pulsatile blood flow in cerebral arteries

Zarrinkoob

Ambarki

Wåhlin

et al. 2016

J Cereb Blood Flow Metab

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Excessive pulsatile flow caused by aortic stiffness is thought to be a contributing factor for several cerebrovascular diseases. The main purpose of this study was to describe the dampening of the pulsatile flow from the proximal to the distal cerebral arteries, the effect of aging and sex, and its correlation to aortic stiffness. Forty-five healthy elderly (mean age 71 years) and 49 healthy young (mean age 25 years) were included. Phase-contrast magnetic resonance imaging was used for measuring blood flow pulsatility index and dampening factor (proximal artery pulsatility index/distal artery pulsatility index) in 21 cerebral and extra-cerebral arteries. Aortic stiffness was measured as aortic pulse wave velocity. Cerebral arterial pulsatility index increased due to aging and this was more pronounced in distal segments of cerebral arteries. There was no difference in pulsatility index between women and men. Dampening of pulsatility index was observed in all cerebral arteries in both age groups but was significantly higher in young subjects than in elderly. Pulse wave velocity was not correlated with cerebral arterial pulsatility index. The increased pulsatile flow in elderly together with reduced dampening supports the pulse wave encephalopathy theory, since it implies that a higher pulsatile flow is reaching distal arterial segments in older subjects.

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“…6 Previous studies have suggested a relationship between increased middle cerebral artery (MCA) pulsatility measured by transcranial Doppler ultrasound and leukoaraiosis or lacunar infarction in patients with hypertension 7 and diabetes, 8 although not necessarily independent of age. However, increased cerebral pulsatility has often been interpreted as a consequence of small vessel disease due to changes in downstream resistance 9 rather than as a causal factor related to increased central arterial stiffness and reduced damping of the cerebral arterial waveform, 10 yet the cerebral circulation appears to be specifically adapted to dampen the arterial waveform 11 and increased aortic stiffness has been associated with leukoaraiosis, 12 lacunar stroke, 13 and cerebral pulsatility. 10 However, these relationships all strongly covary with age and are susceptible to residual confounding.…”

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confidence: 99%

Increased Cerebral Arterial Pulsatility in Patients With Leukoaraiosis

Webb

Simoni²,

Mazzucco³

et al. 2012

Stroke

266

174

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Background and Purpose-Arterial stiffening reduces damping of the arterial waveform and hence increases pulsatility of cerebral blood flow, potentially damaging small vessels. In the absence of previous studies in patients with recent transient ischemic attack or stroke, we determined the associations between leukoaraiosis and aortic and middle cerebral artery stiffness and pulsatility. Methods-Patients were recruited from the Oxford Vascular Study within 6 weeks of a transient ischemic attack or minor stroke. Leukoaraiosis was categorized on MRI by 2 independent observers with the Fazekas and age-related white matter change scales. Middle cerebral artery (MCA) stiffness (transit time) and pulsatility (Gosling's index: MCA-PI) were measured with transcranial ultrasound and aortic pulse wave velocity and aortic systolic, diastolic, and pulse pressure with applanation tonometry (Sphygmocor). Results-In 100 patients, MCA-PI was significantly greater in patients with leukoaraiosis (0.91 versus 0.73, PϽ0.0001).Severity of leukoaraiosis was associated with MCA-PI and aortic pulse wave velocity (Fazekas: 2 ϭ0.39, MCA-PI Pϭ0.01, aortic pulse wave velocity Pϭ0.06; age-related white matter change: 2 ϭ0.38, MCA-PI Pϭ0.015; aortic pulse wave velocity Pϭ0.026) for periventricular and deep white matter lesions independent of aortic systolic blood pressure, diastolic blood pressure, and pulse pressure and MCA transit time with MCA-PI independent of age. In a multivariate model (r 2 ϭ0.68, PϽ0.0001), MCA-PI was independently associated with aortic pulse wave velocity (Pϭ0.016) and aortic pulse pressure (PϽ0.0001) and inversely associated with aortic diastolic blood pressure (PϽ0.0001) and MCA transit time (Pϭ0.001). Conclusions-MCA pulsatility was the strongest physiological correlate of leukoaraiosis, independent of age, and was dependent on aortic diastolic blood pressure and pulse pressure and aortic and MCA stiffness, supporting the hypothesis that large artery stiffening results in increased arterial pulsatility with transmission to the cerebral small vessels resulting in leukoaraiosis. (Stroke. 2012;43:2631-2636.)Key Words: arterial stiffness Ⅲ cerebral pulsatility Ⅲ etiology Ⅲ leukoaraiosis Ⅲ white matter disease P revention of premature leukoaraiosis by treating the underlying causes in middle age may reduce the risk of stroke 1 and dementia 2 and other consequences of cerebral small vessel disease, 3,4 but the etiology is not yet fully understood. The relative importance of hemodynamic factors as opposed to a primary microangiopathy 5 in the development of leukoaraiosis is unclear and associations with age, hypertension, and diabetes are consistent with both processes. 6 Previous studies have suggested a relationship between increased middle cerebral artery (MCA) pulsatility measured by transcranial Doppler ultrasound and leukoaraiosis or lacunar infarction in patients with hypertension 7 and diabetes, 8 although not necessarily independent of age. However, increased cerebral pulsatility has often been interpreted as a...

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Dampening of Blood-Flow Pulsatility along the Carotid Siphon: Does Form Follow Function?

Abstract: BACKGROUND AND PURPOSE:The tortuous distal part of the ICA may have an attenuating effect on pulsatile arterial flow. We investigated local arterial blood flow patterns in the ICA proximal and distal to the carotid siphon to detect quantitative waveform changes.

Cited by 42 publications

References 32 publications

Attenuation of Blood Flow Pulsatility along the Atlas Slope: A Physiologic Property of the Distal Vertebral Artery?

Attenuation of Blood Flow Pulsatility along the Atlas Slope: A Physiologic Property of the Distal Vertebral Artery?

Aging alters the dampening of pulsatile blood flow in cerebral arteries

Increased Cerebral Arterial Pulsatility in Patients With Leukoaraiosis

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