Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

Buratti, Laura; Viticchi, Giovanna; Falsetti, Lorenzo; Balucani, Clotilde; Altamura, Claudia; Petrelli, Cristina; Provinciali, Leandro; Vernieri, Fabrizio; Silvestrini, Mauro

doi:10.1177/0271678x15613526

Cited by 33 publications

(22 citation statements)

References 48 publications

(53 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Cerebral vasomotor reactivity (VMR) to hypercapnia was measured using the breath-holding index (BHI). [22] VMR evaluation preceded TCD microbubble test in all subjects. BH test was performed within 7 days and at least 48 hours from symptom onset in vascular patients and always in the inter-ictal period in MA patients.…”

Section: Methodsmentioning

confidence: 99%

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura

et al. 2019

Self Cite

View full text Add to dashboard Cite

Patent Foramen Ovale and impaired cerebral hemodynamics were proposed among the pathophysiological mechanisms explaining the increased risk for stroke in patients with Migraine with Aura (MA). Our study aimed at comparing the vasomotor reactivity (VMR) of the anterior and the posterior cerebral circulation in patients with Migraine with Aura, in patients with acute vascular ischemic accidents, and in controls. We hypothesized that VMR in MA patients is preserved in the anterior circulation and reduced in the posterior circulation. We prospectively assessed with Transcranial Doppler the vasomotor reactivity to breath holding of the Middle and Posterior Cerebral Arteries (MCA, PCA) in MA patients, in acute vascular patients and healthy controls. We also evaluated the possible effect of clinical characteristics of MA (attack frequency, aura length or type, disease history), vascular factors and the presence of right-to-left shunt on VMR. Diverging from our hypothesis, MA patients displayed a higher breath-holding index (BHI) than controls in the MCA (1.84±0.47%/s vs 1.53±0.47%/s, p = .001) as well as in the PCA (1.87±0.65%/s vs 1.47±0.44%/s, p < .001). In MA patients, MCA BHI was higher in those with large right-to-left shunts (2.09±0.42 vs 1.79±0.47, p = .046) and lower in those taking estrogens (1.30±0.30%/s vs 1.9±0.45%/s, p = .009). We did not observe an effect of MA characteristics on BHI. The increased BHI in MA patients with large right-to-left shunts could be explained by the vasoactive effect in the cerebral circulation of substances bypassing the deactivating pulmonary filters or by a constitutional trait of the vascular system associating persistent right-to-left shunts and hyper-reactive hemodynamics. Our results discourage the hypothesis that altered hemodynamics contribute to increasing the stroke risk in all MA patients. However, estrogens can lower VMR, curtailing the hemodynamic resources of MA patients.

show abstract

Section: Methodsmentioning

confidence: 99%

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura

et al. 2019

Self Cite

View full text Add to dashboard Cite

show abstract

“…1 Although the primary goal of revascularisation therapies is to minimise future embolic events originating from atherosclerotic plaques, the improvement of haemodynamic compromise within the distal vascular bed comes forward as a secondary gain, which is considered to play an important role in long-term morbidities associated with carotid atherosclerosis such as the emergence of white matter (WM) lesions and cognitive dysfunction. 2,3 A number of studies have explored the influence of carotid revascularisation on cerebral haemodynamics, using methodologies like dynamic susceptibility contrast (DSC) 4,5 or arterial spin labelling (ASL), 6,7 perfusion-weighted magnetic resonance imaging (PWI), quantitative magnetic resonance imaging angiography, 8 Xe-133 based flow assessment techniques, 9,10 or single photon emission computed tomography. 11,12 These studies suggest that improvements in cerebral blood flow (CBF) start as early as a few hours following the revascularisation procedure.…”

Section: Introductionmentioning

confidence: 99%

The effect of carotid artery stenting on capillary transit time heterogeneity in patients with carotid artery stenosis

Arsava

Hansen

Kaplan

et al. 2018

European Stroke Journal

View full text Add to dashboard Cite

Introduction: Carotid revascularisation improves haemodynamic compromise in cerebral circulation as an additional benefit to the primary goal of reducing future thromboembolic risk. We determined the effect of carotid artery stenting on cerebral perfusion and oxygenation using a perfusion-weighted MRI algorithm that is based on assessment of capillary transit-time heterogeneity together with other perfusion and metabolism-related metrics. Patients and methods: A consecutive series of 33 patients were evaluated by dynamic susceptibility contrast perfusion-weighted MRI prior to and within 24 h of the endovascular procedure. The level of relative change induced by stenting, and relationship of these changes with respect to baseline stenosis degree were analysed. Results: Stenting led to significant increase in cerebral blood flow (p < 0.001), and decrease in cerebral blood volume (p ¼ 0.001) and mean transit time (p < 0.001); this was accompanied by reduction in oxygen extraction fraction (p < 0.001) and capillary transit-time heterogeneity (p < 0.001), but an overall increase in relative capillary transittime heterogeneity (RTH: CTH divided by MTT; p ¼ 0.008). No significant change was observed with respect to cerebral metabolic rate of oxygen. The median volume of tissue with MTT > 2s decreased from 24 ml to 12 ml (p ¼ 0.009), with CTH > 2s from 29 ml to 19 ml (p ¼ 0.041), and with RTH < 0.9 from 61 ml to 39 ml (p ¼ 0.037) following stenting. These changes were correlated with the baseline degree of stenosis. Discussion: Stenting improved the moderate stage of haemodynamic compromise at baseline in our cohort. The decreased relative transit-time heterogeneity, which increases following stenting, is probably a reflection of decreased functional capillary density secondary to chronic hypoperfusion induced by the proximal stenosis. Conclusion: Carotid artery stenting, is not only important for prophylaxis of future vascular events, but also is critical for restoration of microvascular function in the cerebral tissue.

show abstract

“…For instance, patients with cardiac dysfunction manifest hemodynamic disorders and decreased cerebral perfusion, which subsequently lead to injury or death of neurons [8,9] . Moreover, remodeling and cerebral vasomotor disorders of intracranial or extracranial vessels reduce cerebral perfusion and increase resistance of cerebral arteries, which impair metabolism of nervous tissue and clearance of A-β amyloid, further exacerbate cognitive decline [10][11][12] . Therefore detection of hemodynamic disorders may contribute to identification potentially pathophysiological changes in dementia patients.…”

Section: Introductionmentioning

confidence: 99%

Using hemodynamic parameters quantified with computational fluid dynamics to explore potential mechanisms of occurrence and progression in Alzheimer Disease

Xie

Cheng

Gu³

et al. 2020

Preprint

View full text Add to dashboard Cite

Background: It has gradually recognized that the patients with Alzheimer’s disease (AD) have cerebral hemodynamic disorders. The purpose of the present study was to exploit a novel computational fluid dynamics (CFD) model, which could be used to measure intracranial hemodynamics quantitively in AD patients and to further explore how the hemodynamic changes are involved in progression of AD.Methods: A novel CFD model was constructed by personal magnetic resonance angiography (MRA), vessel ultrasound and blood pressure value of all subjects, of whom included AD patients, vascular dementia (VaD) patients and well-matched healthy controls (HCs). Demographic, clinical and imaging data of all subjects were recorded and analyzed. Quantitative total cerebral blood flow (CBF) and cerebrovascular resistance (CVR) were compared among three groups, in order to ascertain the potential hemodynamic disorders in AD patients.Results: Total CBF and CVR of AD patients were significantly different from those of HCs (both P<0.01), but not different from patients with VaD (both P>0.5), despite the cerebral arteries in AD patients were anatomically intact. Total CBF was negatively correlated with total CVR (rs=-0.822, P<0.001) in AD patients. Comparing with HCs, Elevated CVR (OR=2.25, P=0.004) and age ( OR=2.06, P=0.021) were independent risk factor of AD.Conclusions: CFD can be applied to non-invasively and conveniently quantify and visualize biomechanical changes of cerebral blood flow. Patients with AD have dysfunction of cerebral hemodynamic, including lower CBF and higher CVR, and the CVR was an independent risk factor of AD. These findings provide quantitative evidence to support that increase of cerebrovascular resistance may involve in development of AD.

show abstract

Thresholds of impaired cerebral hemodynamics that predict short-term cognitive decline in asymptomatic carotid stenosis

Cited by 33 publications

References 48 publications

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura

Right-to-left shunts and hormonal therapy influence cerebral vasomotor reactivity in patients with migraine with aura

The effect of carotid artery stenting on capillary transit time heterogeneity in patients with carotid artery stenosis

Using hemodynamic parameters quantified with computational fluid dynamics to explore potential mechanisms of occurrence and progression in Alzheimer Disease

Contact Info

Product

Resources

About