Is blood flow in the middle cerebral artery determined by systemic arterial stiffness?

Kwater, Aleksander; Gąsowski, Jerzy; Gryglewska, Barbara; Wizner, Barbara; Grodzicki, Tomasz

doi:10.1080/08037050902975114

Cited by 42 publications

(33 citation statements)

References 38 publications

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“…To the best of our knowledge, Kwater's study is the only article currently available. 19 This study showed that the PI at the MCA was independently related to age, bPP and cf-PWV. 19 Our current observations expand Kwater's finding by showing that the PI is also related to cPP, the 24-h pulse pressure, and cf-PWV and ba-PWV.…”

Section: Discussionmentioning

confidence: 66%

Blood Flow Pattern in the Middle Cerebral Artery in Relation to Indices of Arterial Stiffness in the Systemic Circulation

Tian

Staessen

Wei

et al. 2012

American Journal of Hypertension

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Section: Discussionmentioning

confidence: 66%

Blood Flow Pattern in the Middle Cerebral Artery in Relation to Indices of Arterial Stiffness in the Systemic Circulation

Tian

Staessen

Wei

et al. 2012

American Journal of Hypertension

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“…There is little information about whether systemic arterial stiffness is associated with parameters of cerebral circulation and SVD [30], and whether PI or BaPWV better correlates with SVD. PI values may be more predictable for SVD because they reflect circulation next to cerebral perforating arteries, whereas BaPWV is an index of systemic arterial stiffness.…”

Section: Discussionmentioning

confidence: 99%

Association between the Severity of Cerebral Small Vessel Disease, Pulsatility of Cerebral Arteries, and Brachial Ankle Pulse Wave Velocity in Patients with Lacunar Infarction

Kim

Choi²,

Moon³

et al. 2010

Eur Neurol

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Background/Aims: Stiff arteries cause high pulse pressure and flow to be transmitted to distal organs during systole, damaging the cerebral microvasculatures. We investigated the association between the severity of cerebral small vessel disease (CSVD), the pulsatility of cerebral arteries, and the stiffness of large arteries in patients with lacunar infarction (LI). Methods: Subjects included 120 patients with LIs, who underwent MRI, transcranial Doppler ultrasonography, and brachial ankle pulse wave velocity (BaPWV). We compared the severity of CSVD, the pulsatile index (PI) of both middle cerebral arteries (MCAs), and BaPWV. Results: Patients with higher BaPWV were more likely to have multiple LIs and more severe white matter lesions, and tended to have higher age, systolic blood pressure, pulse pressure, heart rate, and the PI of MCAs. The PI of MCAs significantly correlated with BaPWV (with PI: r = 0.441, p < 0.001) and age (with PI: r = 0.538, p < 0.001). Multiple linear regression analysis indicated that aging (β = 0.008, p < 0.001) and BaPWV (β = 0.001, p = 0.007) were independent determinants of the PI of MCAs after adjustment for sex, pulse pressure, hypertension, and diabetes. Conclusion: These findings suggest that systemic arterial stiffness may be associated with the severity of CSVD and pulsatility of cerebral arteries.

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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%

“…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. Previous studies have not measured leukoaraiosis, aortic pulse wave velocity (PWV), and middle cerebral pulsatility optimally in the same patient group and no study has also measured aortic pulsatility and middle cerebral artery stiffness, key components of the hypothesized mechanism in which increased aortic pulsatility is transmitted through stiff large vessels to the cerebral microvasculature.…”

mentioning

confidence: 99%

Increased Cerebral Arterial Pulsatility in Patients With Leukoaraiosis

Webb

Simoni²,

Mazzucco³

et al. 2012

Stroke

265

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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Is blood flow in the middle cerebral artery determined by systemic arterial stiffness?

Abstract: Increased PI and RI of MCA are closely related to measures of increased aortic stiffness.

Cited by 42 publications

References 38 publications

Blood Flow Pattern in the Middle Cerebral Artery in Relation to Indices of Arterial Stiffness in the Systemic Circulation

Blood Flow Pattern in the Middle Cerebral Artery in Relation to Indices of Arterial Stiffness in the Systemic Circulation

Association between the Severity of Cerebral Small Vessel Disease, Pulsatility of Cerebral Arteries, and Brachial Ankle Pulse Wave Velocity in Patients with Lacunar Infarction

Increased Cerebral Arterial Pulsatility in Patients With Leukoaraiosis

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