Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion

Kagawa, Shingo; Kishibe, Yoshihiko; Takahashi, Masaaki; Higashi, Tatsuya

doi:10.3174/ajnr.a5110

Cited by 5 publications

(5 citation statements)

References 30 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…As we can expect, impaired perfusion (a decreased CBF/CBV) at baseline was associated with hemodynamic improvement during follow-up. Previous studies showed that medially treated patients with hemodynamic impairment at baseline and no intervening ischemic event had hemodynamic improvement during follow-up, 6–9 which might be related to a reduced stroke risk. In the present study, 8 of the 18 patients with impaired perfusion at baseline did not have impaired perfusion at follow-up.…”

Section: Discussionmentioning

confidence: 97%

“…Patients with ICA or MCA disease with hemodynamic impairment at the baseline that received appropriate treatment and suffered no intervening ischemic events during follow-up, show hemodynamic improvement in the long-term, 6–9 which may be due to long-term improvement of collateral blood flow. 10,11 Patients with hemodynamic impairment necessitating medical treatment have a high risk of subsequent ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

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

Kagawa

Takahashi

Higashi

2017

J Cereb Blood Flow Metab

Self Cite

View full text Add to dashboard Cite

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.

show abstract

Section: Discussionmentioning

confidence: 97%

Section: Introductionmentioning

confidence: 99%

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

Kagawa

Takahashi

Higashi

2017

J Cereb Blood Flow Metab

Self Cite

View full text Add to dashboard Cite

show abstract

“…Blood flow reduction, due to stenotic ICA, was linked to pathologic state of increased oxygen extraction, called misery perfusion, in which maximal vasodilation enables the oxygen supply. It cannot be excluded that this kind of changes lead to selective dendritic and cortical neuronal injury, manifesting among others in CBS-like symptoms ( Yamauchi et al, 2007 ; Yamauchi et al, 2017 ). Some patients, who developed symptoms of CBS, suffered from hypertension.…”

Section: Resultsmentioning

confidence: 99%

The Significance of Vascular Pathogenesis in the Examination of Corticobasal Syndrome

Dunalska

Pikul

Schok

et al. 2021

Front. Aging Neurosci.

View full text Add to dashboard Cite

Corticobasal syndrome (CBS) is a clinical entity, classified as an atypical Parkinsonism, characterized by both motor and higher cortical dysfunctions. The clinical manifestation of CBS is associated with several pathologies, among which corticobasal degeneration (CBD) is the most common. The aim of our study was to elaborate on the possible vascular pathogenesis of CBS and consider types of vascular lesions in these cases. Several cases of vascular CBS are described in the literature. The majority of presented patients were affected by internal carotid artery (ICA) stenosis and ischemic strokes; few cases were associated with vascular malformations or autoimmune diseases. Vascular CBS is preceded by an abrupt onset. The clinical manifestation does not significantly differ with non-vascular CBS. Patients with vascular CBS are usually elderly; often with coexistent hypertension, dyslipidemia and diabetes mellitus. Inferring from our observations, cerebral hypoperfusion can play a significant role in neuropathological changes in neurodegenerative diseases. To the best of our knowledge paper is the first comprehensive review of vascular CBS and we are positive that our observations show that further research concerning the vascular pathogenesis of tauopathy atypical Parkinsonism is required.

show abstract

“…Data from a nationwide community-based study indicated that ischemic stroke accounts for approximately 70% of all incident stroke cases [ 1 ]. For patients with a clinical presentation of ischemic attacks and ineffective medical therapy, superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery has demonstrated significant therapeutic efficacy in numerous studies [ 2 , 3 ]. Several imaging studies have reported that the most crucial goal of surgical revascularization was the reduction of stroke occurrence and improvements in neurological outcomes [ 3 , 4 ].…”

Section: Introductionmentioning

confidence: 99%

“…For patients with a clinical presentation of ischemic attacks and ineffective medical therapy, superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery has demonstrated significant therapeutic efficacy in numerous studies [ 2 , 3 ]. Several imaging studies have reported that the most crucial goal of surgical revascularization was the reduction of stroke occurrence and improvements in neurological outcomes [ 3 , 4 ]. Cerebral ischemic status is an indicator of surgery.…”

Section: Introductionmentioning

confidence: 99%

Crossed cerebellar diaschisis-related supratentorial hemodynamic and metabolic status measured by PET/MR in assessing postoperative prognosis in chronic ischemic cerebrovascular disease patients with bypass surgery

et al. 2022

View full text Add to dashboard Cite

Objective Cerebral ischemic status is an indicator of bypass surgery. Both hemodynamics and glucose metabolism are significant factors for evaluating cerebral ischemic status. The occurrence of crossed cerebellar diaschisis (CCD) is influenced by the degree of supra-tentorial perfusion and glucose metabolism reduction. This study aimed to investigate the relationship between the CCD-related supra-tentorial blood flow and metabolic status before bypass surgery in patients with chronic and symptomatic ischemic cerebrovascular disease and the prognosis of surgery. Methods Twenty-four participants with chronic ischemic cerebrovascular disease who underwent hybrid positron emission tomography (PET)/magnetic resonance (MR) before bypass surgery were included. Arterial spin labeling (ASL)-MR and FDG-PET were used to measure blood flow and metabolism, respectively. The PET images were able to distinguish CCD. The supratentorial asymmetry index (AI) and volume in the decreased blood flow region, decreased metabolism region and co-decreased region on the affected side, except for the infarct area, were respectively obtained before bypass surgery. The neurological status was determined using the National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) scores. Differences between CCD-positive (CCD +) and CCD-negative (CCD−) groups were investigated. Results Fourteen (58%) of the 24 patients were diagnosed as CCD +. Before surgery, the NIHSS and mRS scores of the CCD + were significantly higher than those of the CCD− (1.0(1.0) vs. 0.0(1.0), P = 0.013; 1.0(1.5) vs. 0.0(1.5), P = 0.048). After the surgery, the NIHSS and mRS scores of the CCD + showed a significant decrease (0.0(1.0) to 0.0(0.0), P = 0.011; 0.0(0.5) to 0.0(0.0), P = 0.008). Significant differences were observed in the supra-tentorial decreased metabolism region (all Ps ≤ 0.05) between the CCD + and CCD− groups, but no differences were observed in the preprocedural decreased supratentorial blood flow region (P > 0.05). The preprocedural NIHSS score was strongly correlated with the metabolism AI value in the decreased metabolism region (r = 0.621, P = 0.001) and the co-decreased region (r = 0.571, P = 0.004). Conclusions Supratentorial blood flow and metabolism are important indicators of CCD. This study showed that CCD + patients benefited more from bypass surgery than CCD− patients. Staging based on CCD-related supra-tentorial blood flow and metabolic status by hybrid PET/MR may help to personalize treatment.

show abstract

Progressive Cortical Neuronal Damage and Extracranial-Intracranial Bypass Surgery in Patients with Misery Perfusion

Cited by 5 publications

References 30 publications

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

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

The Significance of Vascular Pathogenesis in the Examination of Corticobasal Syndrome

Crossed cerebellar diaschisis-related supratentorial hemodynamic and metabolic status measured by PET/MR in assessing postoperative prognosis in chronic ischemic cerebrovascular disease patients with bypass surgery

Contact Info

Product

Resources

About