Impaired Cerebral Vasoreactivity and Risk of Stroke in Patients With Asymptomatic Carotid Artery Stenosis

Silvestrini, Mauro; Vernieri, Fabrizio; Pasqualetti, Patrizio; Matteis, Maria; Passarelli, Francesco; Troisi, Elio; Caltagirone, Carlo

doi:10.1001/jama.283.16.2122

Cited by 528 publications

(425 citation statements)

References 33 publications

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“…In addition to vessel surveillance, TCD testing can include assessment of vasomotor reactivity, which may be of interest for providing a more comprehensive indication to surgical treatment in subgroups of subjects with symptomatic and asymptomatic carotid stenosis and occlusions [58,59]. This information is not available from carotid duplex ultrasound examination and may require additional contrast studies with magnetic resonance perfusion or Diamox single photon emission computed tomography or perfusion CT that are costly, and may lead to complications related to vasoactive Diamox effects that last longer than a brief hypercapnia with breath holding.…”

Section: Transcranial Doppler and Transcranial Duplexmentioning

confidence: 99%

Vascular Imaging in Stroke: Comparative Analysis

Barlinn

Alexandrov

2011

Neurotherapeutics

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Advances in stroke treatment have mirrored advances in vascular imaging. Understanding and advances in reperfusion therapies were made possible by improvements in computed tomographic angiography, magnetic resonance angiography, neurovascular ultrasound, and renewed interest in catheter angiography. As technology allows better noninvasive vascular diagnosis, digital subtraction angiography (the remaining gold standard for vascular imaging) is increasingly used for rescue procedures and elective interventions. This review will examine specific advantages and disadvantages of different vascular imaging modalities as related to stroke diagnosis.

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Section: Transcranial Doppler and Transcranial Duplexmentioning

confidence: 99%

Vascular Imaging in Stroke: Comparative Analysis

Barlinn

Alexandrov

2011

Neurotherapeutics

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“…Clinically, impaired CVR has been associated with risk for stroke and transient ischemic attacks (Liu et al, 2012;Zirak et al, 2014). Given similar diagnoses, individuals with CVR impairment have a much higher risk of disabling stroke than those without (Blaser et al, 2002;Bokkers et al, 2011;Kuroda et al, 2004;Mandell et al, 2011;Mandell et al, 2008;Markus and Cullinane, 2001;Schoof et al, 2007;Silvestrini et al, 2000 ;Tsivgoulis and Alexandrov, 2008). In addition, reduced CVR has also been cited as a marker for lacunar infarction (Birns et al, 2009;Mandell et al, 2011), microbleeding (Birns et al, 2009;Conijn et al, 2012), as well as cortical atrophy (Fierstra et al, 2010) and cognitive decline in individuals at risk of stroke (Hurford et al, 2014;Kovács et al, 2010).…”

Section: Introductionmentioning

confidence: 99%

Quantitative mapping of cerebrovascular reactivity using resting-state BOLD fMRI: Validation in healthy adults

2016

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In conventional neuroimaging, cerebrovascular reactivity (CVR) is quantified primarily using the blood-oxygenation level-dependent (BOLD) functional MRI (fMRI) signal, specifically, as the BOLD response to intravascular carbon dioxide (CO 2 ) modulations, in units of [%ΔBOLD/ mmHg]. While this method has achieved wide appeal and clinical translation, the tolerability of CO 2 -related tasks amongst patients and the elderly remains a challenge in more routine and largescale applications. In this work, we propose an improved method to quantify CVR by exploiting intrinsic fluctuations in CO 2 and corresponding changes in the resting-state BOLD signal (rsqCVR). Our rs-qCVR approach requires simultaneous monitoring of PETCO 2 , cardiac pulsation and respiratory volume. In 16 healthy adults, we compare our quantitative CVR estimation technique to the prospective CO 2 -targeting based CVR quantification approach (qCVR, the "standard"). We also compare our rs-CVR to non-quantitative alternatives including the restingstate fluctuation amplitude (RSFA), amplitude of low-frequency fluctuation (ALFF) and globalsignal regression. When all subjects were pooled, only RSFA and ALFF were significantly associated with qCVR. However, for characterizing regional CVR variations within each subject, only the PETCO 2 -based rs-qCVR measure is strongly associated with standard qCVR in 100% of the subjects (p<=0.1). In contrast, for the more qualitative CVR measures, significant withinsubject association with qCVR was only achieved in 50-70% of the subjects. Our work establishes the feasibility of extracting quantitative CVR maps using rs-fMRI, opening the possibility of mapping functional connectivity and qCVR simultaneously.

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“…A reduced absolute cerebral blood flow may result in stroke (Markus 2004) and is a major risk factor for Alzheimer's disease and dementia (de la Torre 2010). In addition, an impaired ability of the cerebral vasculature to respond to changes in PaCO 2 (termed cerebrovascular reactivity) is a risk factor forand a consequence of-cerebrovascular disease (Gur et al 1996;Markus and Cullinane 2001;Silvestrini et al 2000). Assessment of the cerebrovascular response to alterations in PaCO 2 (by measuring changes in middle cerebral artery blood flow velocity (MCAv)) is a wellestablished means to estimate the physiological 'reserve' of cerebral perfusion (Ainslie and Duffin 2009).…”

Section: Introductionmentioning

confidence: 99%

Cerebral blood flow and cerebrovascular reactivity at rest and during sub-maximal exercise: Effect of age and 12-week exercise training

Murrell

Cotter

Thomas

et al. 2012

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165

180

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Chronic reductions in cerebral blood flow (CBF) and cerebrovascular reactivity to CO 2 are risk factors for cerebrovascular disease. Higher aerobic fitness is associated with higher CBF at any age; however, whether CBF or reactivity can be elevated following an exercise training intervention in healthy individuals is unknown. The aim of this study was to assess the effect of exercise training on CBF and cerebrovascular reactivity at rest and during exercise in young and older individuals. Ten young (23±5 years; body mass index ) previously sedentary individuals breathed 5 % CO 2 for 3 min at rest and during steady-state cycling exercise (30 and 70 % heart rate range (HRR)) prior to and following a 12-week aerobic exercise intervention. Effects of training on middle cerebral artery blood velocity (MCAv) at rest were unclear in both age groups. The absolute MCAv response to exercise was greater in the young (9 and 9 cm s −1 (30 and 70 % HRR, respectively) vs. 5 and 4 cm s −1 (older), P<0.05) and was similar following training. Cerebrovascular reactivity was elevated following the 12-week training at rest (2.87±0.76 vs. 2.54± 1.12 cm s −1 mm Hg −1 , P00.01) and during exercise, irrespective of age. The finding of a training-induced elevation in cerebrovascular reactivity provides further support for exercise as a preventative tool in cerebrovascular and neurological disease with ageing.

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Impaired Cerebral Vasoreactivity and Risk of Stroke in Patients With Asymptomatic Carotid Artery Stenosis

Abstract: These results suggest a link between impaired cerebrovascular reactivity and the risk of ischemic events ipsilateral to severe asymptomatic carotid stenosis.

Cited by 528 publications

References 33 publications

Vascular Imaging in Stroke: Comparative Analysis

Vascular Imaging in Stroke: Comparative Analysis

Quantitative mapping of cerebrovascular reactivity using resting-state BOLD fMRI: Validation in healthy adults

Cerebral blood flow and cerebrovascular reactivity at rest and during sub-maximal exercise: Effect of age and 12-week exercise training

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