Long-term hemodynamic changes and blood pressure in atherosclerotic major cerebral artery disease

Abstract

In patients with major cerebral artery disease, lower blood pressure might reduce blood flow in the collateral pathways, thereby impairing the growth of cerebral collaterals, inhibiting hemodynamic improvement. We evaluated the hemodynamic status twice using positron emission tomography and O-gas, over time, in 89 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery disease that had no ischemic episodes during follow-up (mean, 28 ± 23 months). Changes in the mean hemispheric values of hemodynamic parameters in the territory of the diseased artery at follow-up were correlated with the mean blood pressure values at the baseline and follow-up examinations. There was a positive linear relationship between the degree of hemodynamic improvement and systolic blood pressure. Patients with low systolic blood pressure (<130 mmHg) ( n = 18) showed hemodynamic deterioration as indicated by significant decreases in cerebral blood flow, cerebral blood flow/cerebral blood volume ratio, and increases in oxygen extraction fraction during follow-up. In contrast, there were no significant changes in patients without low systolic blood pressure. In patients with atherosclerotic internal carotid artery or middle cerebral artery disease and no ischemic episodes of stroke during follow-up, lower systolic blood pressure was associated with lesser hemodynamic improvement.

Selective neuronal damage and blood pressure in atherosclerotic major cerebral artery disease

“…Low BP might impair the long-term growth of cerebral collaterals 29. In patients with atherosclerotic ICA or MCA disease and no episodes of ischaemic stroke at follow-up, low SBP was associated with haemodynamic deterioration 13. In agreement with this, here we find that lower SBP was associated with a larger increase in OEF at follow-up, which is indicative of haemodynamic deterioration.…”

Misery perfusion and amyloid deposition in atherosclerotic major cerebral artery disease

“…( Gupta and Iadecola, 2015 ) However, the association between cerebral hypoperfusion and amyloid deposition in humans is controversial. Better understanding of this issue is clinically important because the optimal management of vascular risk factors can prevent chronic cerebral hypoperfusion,( Yamauchi et al, 2018 ) which may delay progression of AD. ( Gottesman et al, 2017 ; Larson et al, 2013 )…”

Visit-to-Visit Blood PressureVariations and Hemodynamic Deterioration in Atherosclerotic Major Cerebral ArteryDisease

“…According to the atlas 27 , the ROIs in all 10 images covered the distribution of the MCA as well as the external border zone regions. 10,26 The same ROIs were used for the CMRO 2 , OEF, and CBV images at baseline and the PET images at the third examination co-registered with baseline PET images using the PMOD version 3.204 (PMOD Technologies Ltd., Zurich, Switzerland). The mean hemispheric value for the hemisphere affected by ICA or MCA disease was calculated as the average of all circular ROIs.…”

“…Our previous study in 89 patients with ICA or MCA disease showed that low BP levels were associated with hemodynamic deterioration during the follow-up period. 10 The contribution of low BP levels to the overall variance in hemodynamic changes over time was significant but was not so large; the correlation coefficients between mean systolic BP (SBP) values and changes in cerebral blood flow (CBF) or CBF/cerebral blood volume (CBV) ratio were 0.27 (p < 0.01) and 0.32 (p < 0.005), respectively. This finding suggested that some other factors might have also contribute to the variance in hemodynamic changes.…”