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Bari V, Gelpi F, Cairo B, Anguissola M, Acerbi E, Squillace M, De Maria B, Bertoldo EG, Fiolo V, Callus E, De Vincentiis C, Bedogni F, Ranucci M, Porta A. Impact of surgical aortic valve replacement and transcatheter aortic valve implantation on cardiovascular and cerebrovascular controls: A pilot study. Physiol Rep 2024; 12:e70028. [PMID: 39227321 PMCID: PMC11371460 DOI: 10.14814/phy2.70028] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/09/2024] [Revised: 08/23/2024] [Accepted: 08/23/2024] [Indexed: 09/05/2024] Open
Abstract
Surgical aortic valve replacement (SAVR) and transcatheter aortic valve implantation (TAVI) are options in severe aortic valve stenosis (AVS). Cardiovascular (CV) and cerebrovascular (CBV) control markers, derived from variability of heart period, systolic arterial pressure, mean cerebral blood velocity and mean arterial pressure, were acquired in 19 AVS patients (age: 76.8 ± 3.1 yrs, eight males) scheduled for SAVR and in 19 AVS patients (age: 79.9 + 6.5 yrs, 11 males) scheduled for TAVI before (PRE) and after intervention (POST, <7 days). Left ventricular function was preserved in both groups. Patients were studied at supine resting (REST) and during active standing (STAND). We found that: (i) both SAVR and TAVI groups featured a weak pre-procedure CV control; (ii) TAVI ensured better CV control; (iii) cerebral autoregulation was working in PRE in both SAVR and TAVI groups; (iv) SAVR and TAVI had no impact on the CBV control; (v) regardless of group, CV and CBV control markers were not influenced by STAND in POST. Even though the post-procedure preservation of both CV and CBV controls in TAVI group might lead to privilege this procedure in patients at higher risk, the missing response to STAND suggests that this advantage could be insignificant.
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Affiliation(s)
- Vlasta Bari
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
- Department of Cardiothoracic, Vascular Anesthesia and Intensive CareIRCCS Policlinico San DonatoMilanItaly
| | - Francesca Gelpi
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | - Beatrice Cairo
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
| | - Martina Anguissola
- Department of Cardiothoracic, Vascular Anesthesia and Intensive CareIRCCS Policlinico San DonatoMilanItaly
| | - Elena Acerbi
- Department of Clinical and Interventional CardiologyIRCCS Policlinico San DonatoMilanItaly
| | - Mattia Squillace
- Department of Clinical and Interventional CardiologyIRCCS Policlinico San DonatoMilanItaly
| | | | | | - Valentina Fiolo
- Clinical Psychology ServiceIRCCS Policlinico San DonatoMilanItaly
| | - Edward Callus
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
- Clinical Psychology ServiceIRCCS Policlinico San DonatoMilanItaly
| | | | - Francesco Bedogni
- Department of Clinical and Interventional CardiologyIRCCS Policlinico San DonatoMilanItaly
| | - Marco Ranucci
- Department of Cardiothoracic, Vascular Anesthesia and Intensive CareIRCCS Policlinico San DonatoMilanItaly
| | - Alberto Porta
- Department of Biomedical Sciences for HealthUniversity of MilanMilanItaly
- Department of Cardiothoracic, Vascular Anesthesia and Intensive CareIRCCS Policlinico San DonatoMilanItaly
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Ince J, Panerai RB, Salinet ASM, Lam MY, Llwyd O, Haunton VJ, Robinson TG, Minhas JS. Dynamics of Critical Closing Pressure Explain Cerebral Autoregulation Impairment in Acute Cerebrovascular Disease. Cerebrovasc Dis 2024:1-9. [PMID: 38964310 DOI: 10.1159/000540206] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2024] [Accepted: 06/06/2024] [Indexed: 07/06/2024] Open
Abstract
INTRODUCTION Cerebral autoregulation (CA) is impaired in acute ischemic stroke (AIS) and is associated with worse patient outcomes, but the underlying physiological cause is unclear. This study tests whether depressed CA in AIS can be linked to the dynamic responses of critical closing pressure (CrCP) and resistance area product (RAP). METHODS Continuous recordings of middle cerebral blood velocity (MCAv, transcranial Doppler), arterial blood pressure (BP), end-tidal CO2 and electrocardiography allowed dynamic analysis of the instantaneous MCAv-BP relationship to obtain estimates of CrCP and RAP. The dynamic response of CrCP and RAP to a sudden change in mean BP was obtained by transfer function analysis. Comparisons were made between younger controls (≤50 years), older controls (>50 years), and AIS patients. RESULTS Data from 24 younger controls (36.4 ± 10.9 years, 9 male), 38 older controls (64.7 ± 8.2 years, 20 male), and 20 AIS patients (63.4 ± 13.8 years, 9 male) were included. Dynamic CA was impaired in AIS, with lower autoregulation index (affected hemisphere: 4.0 ± 2.3, unaffected: 4.5 ± 1.8) compared to younger (right: 5.8 ± 1.4, left: 5.8 ± 1.4) and older (right: 4.9 ± 1.6, left: 5.1 ± 1.5) controls. AIS patients also demonstrated an early (0-3 s) peak in CrCP dynamic response that was not influenced by age. CONCLUSION These early transient differences in the CrCP dynamic response are a novel finding in stroke and occur too early to reflect underlying regulatory mechanisms. Instead, these may be caused by structural changes to cerebral vasculature.
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Affiliation(s)
- Jonathan Ince
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Ronney B Panerai
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Angela S M Salinet
- Neurology Department, Hospital das Clinicas, School of Medicine, University of São Paulo, São Paulo, Brazil
| | - Man Y Lam
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Osian Llwyd
- Wolfson Centre for Prevention of Stroke and Dementia, Department of Clinical Neurosciences, University of Oxford, Oxford, UK
| | - Victoria J Haunton
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
| | - Thompson G Robinson
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
| | - Jatinder S Minhas
- Cerebral Haemodynamics in Ageing and Stroke Medicine (CHiASM) Group, Department of Cardiovascular Sciences, University of Leicester, Leicester, UK
- NIHR Leicester Biomedical Research Centre, Leicester, UK
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Jumah A, Fu S, Albanna AJ, Agarwal U, Fana M, Choudhury O, Idris A, Elfaham A, Iqbal Z, Schultz L, Latack K, Brady M, Scozzari D, Ramadan AR. Early vs late anticoagulation in acute ischemic stroke with indications outside atrial fibrillation. J Stroke Cerebrovasc Dis 2024; 33:107757. [PMID: 38705498 DOI: 10.1016/j.jstrokecerebrovasdis.2024.107757] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2024] [Revised: 04/07/2024] [Accepted: 05/01/2024] [Indexed: 05/07/2024] Open
Abstract
BACKGROUND Current literature lacks guidance on the safety of administering anticoagulation in acute ischemic stroke with emergent indications that require anticoagulation other than atrial fibrillation. Therefore, we tend to rely on studies investigating acute ischemic stroke in atrial fibrillation for anticoagulation recommendations. METHODS We retrospectively reviewed data for patients with acute ischemic stroke who had a non-atrial fibrillation emergent indication for anticoagulation (e.g., intra-arterial thrombus, intracardiac thrombus, acute coronary syndrome, acute limb ischemia, deep vein thrombosis and pulmonary embolism) diagnosed within 3 days of acute ischemic stroke. Patients who received anticoagulation ≤ 3 days of stroke onset (Group A) were compared to those who either received it afterwards or did not receive it at all (Group B). RESULTS Out of the 558 patients, only 88 patients met our inclusion criteria. Of the total cohort, 55.7 % patients were males, and basic demographics were similar in both groups except for milder strokes in Group A (national institute of health stroke scale 6 vs. 12.5, p = 0.03). Only 2 patients in Group A and 1 patient in Group B developed intracranial hemorrhage, which was not statistically significant. Group A patients had a lower incidence of both new diagnosis (2 % vs. 34.2 % %, p < 0.001) and propagation of an established venous thromboembolism. They also had a lower rate of any thromboembolic complication (2 % vs. 42 %, p < 0.001). CONCLUSION Early anticoagulation (i.e., ≤ 3 days) in non-atrial fibrillation ischemic stroke patients with an emergent indication may be safe and carry a lower risk of thromboembolic complications than later anticoagulation.
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Affiliation(s)
- Ammar Jumah
- Department of Neurology, Henry Ford Health, Detroit, MI, USA.
| | - Siyuan Fu
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | | | - Utkarsh Agarwal
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Michael Fana
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Omar Choudhury
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Anas Idris
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | | | - Zahid Iqbal
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Lonni Schultz
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Katie Latack
- Department of Public Health Sciences, Henry Ford Health, Detroit, MI, USA
| | - Megan Brady
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
| | - Dawn Scozzari
- Department of Neurology, Henry Ford Health, Detroit, MI, USA
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Ma K, Bebawy JF. Anemia and Optimal Transfusion Thresholds in Brain-Injured Patients: A Narrative Review of the Literature. Anesth Analg 2024; 138:992-1002. [PMID: 38109853 DOI: 10.1213/ane.0000000000006772] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2023]
Abstract
Anemia is a highly prevalent condition that may compromise oxygen delivery to vital organs, especially among the critically ill. Although current evidence supports the adoption of a restrictive transfusion strategy and threshold among the nonbleeding critically ill patient, it remains unclear whether this practice should apply to the brain-injured patient, given the predisposition to cerebral ischemia in this patient population, in which even nonprofound anemia may exert a detrimental effect on clinical outcomes. The purpose of this review is to provide an overview of the pathophysiological changes related to impaired cerebral oxygenation in the brain-injured patient and to present the available evidence on the effect of anemia and varying transfusion thresholds on the clinical outcomes of patients with acute brain injury.
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Affiliation(s)
- Kan Ma
- From the Department of Anesthesiology and Pain Medicine, St Michael's Hospital, University of Toronto, Toronto, Ontario, Canada
| | - John F Bebawy
- Department of Anesthesiology and Neurological Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
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Whitaker AA, Aaron SE, Chertoff M, Brassard P, Buchanan J, Nguyen K, Vidoni ED, Waghmare S, Eickmeyer SM, Montgomery RN, Billinger SA. Lower dynamic cerebral autoregulation following acute bout of low-volume high-intensity interval exercise in chronic stroke compared to healthy adults. J Appl Physiol (1985) 2024; 136:707-720. [PMID: 38357728 DOI: 10.1152/japplphysiol.00635.2023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/08/2023] [Revised: 01/23/2024] [Accepted: 02/04/2024] [Indexed: 02/16/2024] Open
Abstract
Fluctuating arterial blood pressure during high-intensity interval exercise (HIIE) may challenge dynamic cerebral autoregulation (dCA), specifically after stroke after an injury to the cerebrovasculature. We hypothesized that dCA would be attenuated at rest and during a sit-to-stand transition immediately after and 30 min after HIIE in individuals poststroke compared with age- and sex-matched control subjects (CON). HIIE switched every minute between 70% and 10% estimated maximal watts for 10 min. Mean arterial pressure (MAP) and middle cerebral artery blood velocity (MCAv) were recorded. dCA was quantified during spontaneous fluctuations in MAP and MCAv via transfer function analysis. For sit-to-stand, time delay before an increase in cerebrovascular conductance index (CVCi = MCAv/MAP), rate of regulation, and % change in MCAv and MAP were measured. Twenty-two individuals poststroke (age 60 ± 12 yr, 31 ± 16 mo) and twenty-four CON (age 60 ± 13 yr) completed the study. Very low frequency (VLF) gain (P = 0.02, η2 = 0.18) and normalized gain (P = 0.01, η2 = 0.43) had a group × time interaction, with CON improving after HIIE whereas individuals poststroke did not. Individuals poststroke had lower VLF phase (P = 0.03, η2 = 0.22) after HIIE compared with CON. We found no differences in the sit-to-stand measurement of dCA. Our study showed lower dCA during spontaneous fluctuations in MCAv and MAP following HIIE in individuals poststroke compared with CON, whereas the sit-to-stand response was maintained.NEW & NOTEWORTHY This study provides novel insights into poststroke dynamic cerebral autoregulation (dCA) following an acute bout of high-intensity interval exercise (HIIE). In people after stroke, dCA appears attenuated during spontaneous fluctuations in mean arterial pressure (MAP) and middle cerebral artery blood velocity (MCAv) following HIIE. However, the dCA response during a single sit-to-stand transition after HIIE showed no significant difference from controls. These findings suggest that HIIE may temporarily challenge dCA after exercise in individuals with stroke.
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Affiliation(s)
- Alicen A Whitaker
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, United States
- Department of Physical Medicine and Rehabilitation, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
- Cardiovascular Center, Medical College of Wisconsin, Milwaukee, Wisconsin, United States
| | - Stacey E Aaron
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Mark Chertoff
- Department of Hearing and Speech, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Quebec City, Quebec, Canada
- Research Center of the Institut Universitaire de Cardiologie et de Pneumologie de Québec-Université Laval, Quebec City, Quebec, Canada
| | - Jake Buchanan
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Katherine Nguyen
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Eric D Vidoni
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, United States
- University of Kansas Alzheimer's Disease Research Center, Fairway, Kansas, United States
| | - Saniya Waghmare
- Department of Physical Therapy, Rehabilitation Science, and Athletic Training, University of Kansas Medical Center, Kansas City, Kansas, United States
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Sarah M Eickmeyer
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Robert N Montgomery
- Department of Biostatistics & Data Science, University of Kansas Medical Center, Kansas City, Kansas, United States
| | - Sandra A Billinger
- Department of Neurology, University of Kansas Medical Center, Kansas City, Kansas, United States
- University of Kansas Alzheimer's Disease Research Center, Fairway, Kansas, United States
- Department of Physical Medicine and Rehabilitation, University of Kansas Medical Center, Kansas City, Kansas, United States
- Department of Cell Biology and Physiology, University of Kansas Medical Center, Kansas City, Kansas, United States
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Sico JJ, Hu X, Myers LJ, Levine D, Bravata DM, Arling GW. Real-world analysis of two ischaemic stroke and TIA systolic blood pressure goals on 12-month mortality and recurrent vascular events. Stroke Vasc Neurol 2024:svn-2023-002759. [PMID: 38191185 DOI: 10.1136/svn-2023-002759] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2023] [Accepted: 12/12/2023] [Indexed: 01/10/2024] Open
Abstract
INTRODUCTION Whether obtaining the more intensive goal systolic blood pressure (SBP) of <130 mm Hg, rather than a less intensive SBP goal of <140 mm Hg poststroke/transient ischaemic attack (TIA) is associated with incremental mortality and recurrent vascular event benefit is largely unexplored using real-world data. Lowering SBP excessively may result in poorer outcomes. METHODS This is a retrospective cohort study of 26 368 Veterans presenting to a Veterans Administration Medical Center (VAMC) with a stroke/TIA between October 2015 and July 2018. Patients were excluded from the study if they had missing or extreme BP values, receiving dialysis or palliative care, left against medical advice had a cancer diagnosis, were cared for in a VAMC enrolled in a stroke/TIA quality improvement initiative, died or had a cerebrovascular or cardiovascular event within 90 days after their index stroke/TIA. The analytical sample included 12 337 patients. Average SBP during 90 days after discharge was assessed in categories (≤105 mm Hg, 106-115 mm Hg, 116-130 mm Hg, 131-140 mm Hg and >140 mm Hg). Separate multivariable Cox proportional hazard regressions were used to examine the relationship between average SBP groups and time to: (1) mortality and (2) any recurrent vascular event, from 90 days to up to 365 days after discharge from the index emergency department visit or inpatient admission. RESULTS Compared with those with SBP>140 mm Hg, patients with SBP between 116 and 130 mm Hg had a significantly lower risk of recurrent stroke/TIA (HR 0.77, 95% CI 0.60 to 0.99) but not cardiovascular events. Patients with SBP lower than 105 mm Hg, compared with those with >140 mm Hg demonstrated a statistically significant higher risk of death (HR 2.07, 95% CI 1.43 to 3.00), but no statistical differences were found in other SBP groups. DISCUSSION Data support a more intensive SBP goal to prevent recurrent cerebrovascular events among stroke/TIA patients by 90 days poststroke/TIA compared with less intensive goal. Very low SBPs were associated with increased mortality risk.
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Affiliation(s)
- Jason J Sico
- Internal Medicine and Neurology, Yale University School of Medicine, New Haven, Connecticut, USA
- Department of Neurology, Veterans Affairs Connecticut Healthcare System, West Haven, Connecticut, USA
| | - Xin Hu
- Yale School of Public Health, New Haven, Connecticut, USA
| | - Laura J Myers
- VA Health Services Research and Development (HSR&D) Center for Healthcare Informatics and Communication and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA
- Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Deborah Levine
- Departments of Medicine and Neurology, University of Michigan School of Medicine, Ann Arbor, Michigan, USA
| | - Dawn M Bravata
- Health Services Research and Development (HSR&D) Center for Healthcare Informatics and Communication and the HSR&D Stroke Quality Enhancement Research Initiative (QUERI); Richard L. Roudebush VA Medical Center, Indianapolis, Indiana, USA
| | - Greg W Arling
- Department of Veterans Affairs (VA), Health Services Research and Development (HSR&D) Precision Monitoring to Transform Care (PRISM) Quality Enhancement Research Initiative (QUERI), Indianapolis, Indiana, USA
- Department of Nursing, Purdue University, West Lafayette, Indiana, USA
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Xu J, Li H, Jin G, Zhuang W, Bai Z, Sun J, Chen M, Wang F, Yang X, Qin M. Conductivity reactivity index for monitoring of cerebrovascular autoregulation in early cerebral ischemic rabbits. Biomed Eng Online 2023; 22:78. [PMID: 37559130 PMCID: PMC10410901 DOI: 10.1186/s12938-023-01142-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2023] [Accepted: 07/27/2023] [Indexed: 08/11/2023] Open
Abstract
BACKGROUND Cerebrovascular autoregulation (CVAR) is the mechanism that maintains constant cerebral blood flow by adjusting the caliber of the cerebral vessels. It is important to have an effective, contactless way to monitor and assess CVAR in patients with ischemia. METHODS The adjustment of cerebral blood flow leads to changes in the conductivity of the whole brain. Here, whole-brain conductivity measured by the magnetic induction phase shift method is a valuable alternative to cerebral blood volume for non-contact assessment of CVAR. Therefore, we proposed the correlation coefficient between spontaneous slow oscillations in arterial blood pressure and the corresponding magnetic induction phase shift as a novel index called the conductivity reactivity index (CRx). In comparison with the intracranial pressure reactivity index (PRx), the feasibility of the conductivity reactivity index to assess CVAR in the early phase of cerebral ischemia has been preliminarily confirmed in animal experiments. RESULTS There was a significant difference in the CRx between the cerebral ischemia group and the control group (p = 0.002). At the same time, there was a significant negative correlation between the CRx and the PRx (r = - 0.642, p = 0.002) after 40 min after ischemia. The Bland-Altman consistency analysis showed that the two indices were linearly related, with a minimal difference and high consistency in the early ischemic period. The sensitivity and specificity of CRx for cerebral ischemia identification were 75% and 20%, respectively, and the area under the ROC curve of CRx was 0.835 (SE = 0.084). CONCLUSION The animal experimental results preliminarily demonstrated that the CRx can be used to monitor CVAR and identify CVAR injury in early ischemic conditions. The CRx has the potential to be used for contactless, global, bedside, and real-time assessment of CVAR of patients with ischemic stroke.
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Affiliation(s)
- Jia Xu
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Haocheng Li
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
- Department of Medical Engineering, General Hospital of Central Theater Command, Wuhan, China
| | - Gui Jin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Wei Zhuang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Zelin Bai
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Jian Sun
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Mingsheng Chen
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Feng Wang
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China
| | - Xu Yang
- Department of Medical Service, General Hospital of Central Theater Command, Wuhan, China
| | - Mingxin Qin
- College of Biomedical Engineering, Third Military Medical University (Army Medical University), Chongqing, China.
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Renthlei L, Mariappan R, Raju K, Joseph J. Challenges of anaesthetising a child with Bow Hunter's syndrome and dilated cardiomyopathy for occipitocervical fusion. BMJ Case Rep 2023; 16:e253834. [PMID: 37130633 PMCID: PMC10163423 DOI: 10.1136/bcr-2022-253834] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/04/2023] Open
Abstract
Paediatric Bow Hunter's syndrome (BHS), or rotational vertebral artery syndrome, is a rare cause of posterior circulation insufficiency in children. It results from mechanical obstruction of the vertebral artery by the transverse process of cervical vertebrae resulting in vertebrobasilar insufficiency during the neck rotation to the sides. Paediatric dilated cardiomyopathy (DCM) is a rare myocardial disease that presents with ventricular dilatation and cardiac dysfunction. This case report describes the successful anaesthetic management of an boy with BHS due to atlantoaxial dislocation and DCM. The child was anaesthetised by keeping the following anaesthetic goals in mind such as maintenance of the heart rate, rhythm, preload, afterload and contractility close to the baseline for both DCM and BHS. Haemodynamic management with optimal fluids, inotrope and a vasopressor and titrating its volume and doses using multimodal haemodynamic monitoring while keeping both cardio and neuroprotective strategies, and the multimodal analgesia techniques helped the child for faster recovery.
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Affiliation(s)
- Lalrinhlui Renthlei
- Department of Anaesthesia, Christian Medical College, Vellore, Tamilnadu, India
| | - Ramamani Mariappan
- Department of Neuroanaesthesia, Christian Medical College, Vellore, Tamil Nadu, India
| | - Krishnaprabhu Raju
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India
| | - Jeena Joseph
- Department of Neurological Sciences, Christian Medical College, Vellore, Tamilnadu, India
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Bahouth MN, Deluzio S, Pruski A, Zink EK. Nonpharmacological Treatments for Hospitalized Patients with Stroke: A Nuanced Approach to Prescribing Early Activity. Neurotherapeutics 2023; 20:712-720. [PMID: 37289401 PMCID: PMC10275818 DOI: 10.1007/s13311-023-01392-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/18/2023] [Indexed: 06/09/2023] Open
Abstract
Stroke remains a leading cause of adult disability. To date, hyperacute revascularization procedures reach 5-10% of stroke patients even in high resource health systems. There is a limited time window for brain repair after stroke, and therefore, the activities such as prescribed exercise in the earliest period will likely have long-term significant consequences. Clinicians who provide care for hospitalized stroke patients make treatment decisions specific to activity often without guidelines to direct these prescriptions. This requires a balanced understanding of the available evidence for early post-stroke exercise and physiological principles after stroke that drive the safety of prescribed exercise. Here, we provide a summary of these relevant concepts, identify gaps, and recommend an approach to prescribing safe and meaningful activity for all patients with stroke. The population of thrombectomy-eligible stroke patients can be used as the exemplar for conceptualization.
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Affiliation(s)
- Mona N Bahouth
- Department of Neurology, Johns Hopkins School of Medicine, 600 N Wolfe St; Phipps 486, Baltimore, MD, 21287, USA.
| | - Sandra Deluzio
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, USA
| | - April Pruski
- Department of Physical Medicine and Rehabilitation, Johns Hopkins School of Medicine, Baltimore, USA
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Gohel D, Shukla S, Rajan WD, Wojtas B, Kaminska B, Singh R. Altered trafficking of miRNAs at mitochondria modulates mitochondrial functions and cell death in brain ischemia. Free Radic Biol Med 2023; 199:26-33. [PMID: 36781060 DOI: 10.1016/j.freeradbiomed.2023.02.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/17/2022] [Revised: 01/31/2023] [Accepted: 02/07/2023] [Indexed: 02/13/2023]
Abstract
Stroke is one of the major causes of death and disabilities worldwide. The rapid induction of cell death by necrosis and apoptosis is observed at the ischemic core, while long lasting apoptosis and brain inflammation continue in the penumbra. The emerging evidence suggests a critical role of mitochondria in acute and chronic inflammation and cell death. Mitochondrial dysfunction may result in the release of mitokines and/or mitochondrial DNA into the cytoplasm and activate multiple cytosolic pathways which in turn triggers inflammation. The role of miRNA, specifically mitochondria-associated miRNAs (mitomiRs) in the regulation of mitochondrial functions is emerging. In the current study, we hypothesized that ischemia-induced mitomiRs may modulate the mitochondrial functions and such alterations under stress conditions may lead to mitochondrial dysfunction and cell death. We have demonstrated the specific pattern of miRNAs associated with mitochondria that is altered under ischemic condition induced by transient middle artery occlusion (tMCAo) in rats. The putative targets of altered miRNAs include several mitochondrial proteins which signifies their involvement in maintaining mitochondrial homeostasis. The alteration of selected miRNAs in mitochondria was further detected in a cellular models when hypoxia was induced using a chemical agent CoCl2, in three cell lines. Two candidate mitomiRs, hsa-miR-149-3p and hsa-miR-204-5p were further analyzed for their functional role during in vitro hypoxia by transfecting mitomiR mimics into cells and determining critical mitochondrial functions and cell viability. The results here emphasize the role of certain mitomiRs as an important modulator of mitochondrial function under the ischemic condition.
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Affiliation(s)
- Dhruv Gohel
- Department of Biochemistry, Faculty of Science, The M.S. University of Baroda, Vadodara, 390002, Gujarat, India; Department of Genomic Medicine, Lerner Research Institute, Cleveland Clinic, Cleveland, OH, 44195, USA
| | - Shatakshi Shukla
- Department of Biochemistry, Faculty of Science, The M.S. University of Baroda, Vadodara, 390002, Gujarat, India
| | - Wenson David Rajan
- Laboratory of Molecular Neurobiology, The Nencki Institute of Experimental Biology of the Polish Academy of Sciences, 02-093, Warsaw, Poland
| | - Bartosz Wojtas
- Laboratory of Molecular Neurobiology, The Nencki Institute of Experimental Biology of the Polish Academy of Sciences, 02-093, Warsaw, Poland
| | - Bozena Kaminska
- Laboratory of Molecular Neurobiology, The Nencki Institute of Experimental Biology of the Polish Academy of Sciences, 02-093, Warsaw, Poland.
| | - Rajesh Singh
- Department of Biochemistry, Faculty of Science, The M.S. University of Baroda, Vadodara, 390002, Gujarat, India; Department of Molecular and Human Genetics, Banaras Hindu University, Varanasi, 221005, India.
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11
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De Georgia M, Bowen T, Duncan KR, Chebl AB. Blood pressure management in ischemic stroke patients undergoing mechanical thrombectomy. Neurol Res Pract 2023; 5:12. [PMID: 36991520 PMCID: PMC10061853 DOI: 10.1186/s42466-023-00238-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Accepted: 03/14/2023] [Indexed: 03/31/2023] Open
Abstract
The relationship between presenting blood pressure in acute ischemic stroke patients and outcome is complex. Several studies have demonstrated a U-shaped curve with worse outcomes when blood pressure is high or low. The American Heart Association/American Stroke Association guidelines recommend values of blood pressure < 185/110 mmHg in patients treated with intravenous t-PA and "permissive hypertension" up to 220/120 mmHg in those not treated with intravenous t-PA. The optimal blood pressure target is less clear in patients undergoing mechanical thrombectomy. Before thrombectomy, the guidelines recommend a blood pressure < 185/110 mmHg though patients with even lower systolic blood pressures may have better outcomes. During and after thrombectomy, the guidelines recommend a blood pressure < 180/105 mmHg. However, several studies have suggested that during thrombectomy the primary goal should be to prevent significant low blood pressure (e.g., target systolic blood pressure > 140 mmHg or MAP > 70 mmHg). After thrombectomy, the primary goal should be to prevent high blood pressure (e.g., target systolic blood pressure < 160 mmHg or MAP < 90 mmHg). To make more specific recommendations, large, randomized-control studies are needed that address factors such as the baseline blood pressure, timing and degree of revascularization, status of collaterals, and estimated risk of reperfusion injury.
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Affiliation(s)
- Michael De Georgia
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA.
| | - Theodore Bowen
- Department of Neurology, MetroHealth Medical Center, Cleveland, OH, USA
| | - K Rose Duncan
- Department of Neurology, Case Western Reserve University School of Medicine, Cleveland, OH, USA
| | - Alex Bou Chebl
- Department of Neurology, Henry Ford Medical Center, Detroit, MI, USA
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12
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Mankoo A, Roy S, Davies A, Panerai RB, Robinson TG, Brassard P, Beishon LC, Minhas JS. The role of the autonomic nervous system in cerebral blood flow regulation in stroke: A review. Auton Neurosci 2023; 246:103082. [PMID: 36870192 DOI: 10.1016/j.autneu.2023.103082] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/24/2021] [Revised: 11/22/2022] [Accepted: 02/22/2023] [Indexed: 03/02/2023]
Abstract
Stroke is a pathophysiological condition which results in alterations in cerebral blood flow (CBF). The mechanism by which the brain maintains adequate CBF in presence of fluctuating cerebral perfusion pressure (CPP) is known as cerebral autoregulation (CA). Disturbances in CA may be influenced by a number of physiological pathways including the autonomic nervous system (ANS). The cerebrovascular system is innervated by adrenergic and cholinergic nerve fibers. The role of the ANS in regulating CBF is widely disputed owing to several factors including the complexity of the ANS and cerebrovascular interactions, limitations to measurements, variation in methods to assess the ANS in relation to CBF as well as experimental approaches that can or cannot provide insight into the sympathetic control of CBF. CA is known to be impaired in stroke however the number of studies investigating the mechanisms by which this occurs are limited. This literature review will focus on highlighting the assessment of the ANS and CBF via indices derived from the analyses of heart rate variability (HRV), and baroreflex sensitivity (BRS), and providing a summary of both clinical and animal model studies investigating the role of the ANS in influencing CA in stroke. Understanding the mechanisms by which the ANS influences CBF in stroke patients may provide the foundation for novel therapeutic approaches to improve functional outcomes in stroke patients.
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Affiliation(s)
- Alex Mankoo
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Sankanika Roy
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom.
| | - Aaron Davies
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Ronney B Panerai
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Thompson G Robinson
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
| | - Patrice Brassard
- Department of Kinesiology, Faculty of Medicine, Université Laval, Québec, QC, Canada; Research center of the Institut universitaire de cardiologie et de pneumologie de Québec-Université Laval, Québec, QC, Canada
| | - Lucy C Beishon
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom
| | - Jatinder S Minhas
- University of Leicester, Department of Cardiovascular Sciences, Leicester, United Kingdom; NIHR Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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13
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microRNAs Associated with Carotid Plaque Development and Vulnerability: The Clinician's Perspective. Int J Mol Sci 2022; 23:ijms232415645. [PMID: 36555285 PMCID: PMC9779323 DOI: 10.3390/ijms232415645] [Citation(s) in RCA: 12] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2022] [Accepted: 12/07/2022] [Indexed: 12/14/2022] Open
Abstract
Ischemic stroke (IS) related to atherosclerosis of large arteries is one of the leading causes of mortality and disability in developed countries. Atherosclerotic internal carotid artery stenosis (ICAS) contributes to 20% of all cerebral ischemia cases. Nowadays, atherosclerosis prevention and treatment measures aim at controlling the atherosclerosis risk factors, or at the interventional (surgical or endovascular) management of mature occlusive lesions. There is a definite lack of the established circulating biomarkers which, once modulated, could prevent development of atherosclerosis, and consequently prevent the carotid-artery-related IS. Recent studies emphasize that microRNA (miRNA) are the emerging particles that could potentially play a pivotal role in this approach. There are some research studies on the association between the expression of small non-coding microRNAs with a carotid plaque development and vulnerability. However, the data remain inconsistent. In addition, all major studies on carotid atherosclerotic plaque were conducted on cell culture or animal models; very few were conducted on humans, whereas the accumulating evidence demonstrates that it cannot be automatically extrapolated to processes in humans. Therefore, this paper aims to review the current knowledge on how miRNA participate in the process of carotid plaque formation and rupture, as well as stroke occurrence. We discuss potential target miRNA that could be used as a prognostic or therapeutic tool.
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14
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Zhang Y, Zhao B, Lai Q, Li Q, Tang X, Zhang Y, Pan Z, Gao Q, Zhong Z. Chronic cerebral hypoperfusion and blood-brain barrier disruption in uninjured brain areas of rhesus monkeys subjected to transient ischemic stroke. J Cereb Blood Flow Metab 2022; 42:1335-1346. [PMID: 35137610 PMCID: PMC9207497 DOI: 10.1177/0271678x221078065] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Blood-brain barrier (BBB) disruption is a pivotal pathophysiological process in ischemic stroke. Although temporal changes in BBB permeability during the acute phase have been widely studied, little is known about the chronic phase of cerebrovascular changes that may have a large impact on the long-term outcome. Therefore, this study was aimed to measure cerebral vascular abnormalities using CT perfusion in nine rhesus monkeys subjected to transient middle cerebral artery occlusion (tMCAO) for ≥1 year (MCAO-1Y+). The level of cerebral perfusion demonstrated by mean transit time was significantly higher in the ipsilateral caudate nucleus, white matter, thalamus, hippocampus, and contralateral thalamus in MCAO-1Y+ compared with the other nine age-matched control monkeys. The increase in BBB permeability measured through the permeability surface was found in the same ten regions of interest ipsilaterally and contralaterally. We also found decreased levels of Aβ 42/40 ratio in the cerebrospinal fluid (CSF), suggesting a potential link between post-MCAO cognitive decline and Aβ metabolism. Overall, we demonstrated significant cerebral hypoperfusion, BBB disruption, and CSF Aβ decrease during the rehabilitation stage of ischemic stroke in a non-human primate model. Future studies are needed to elucidate the cause-effect relationship between cerebrovascular disruptions and long-term neurological deficits.
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Affiliation(s)
- Yingqian Zhang
- Laboratory of Nonhuman Primate Disease Modeling Research, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China.,School of Basic Medical Science, Southwest Medical University, Luzhou, China
| | - Bangcheng Zhao
- Laboratory of Nonhuman Primate Disease Modeling Research, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
| | - Qi Lai
- Department of Thoracic Surgery, Sichuan Cancer Hospital and Institute, Chengdu, China
| | - Qinxi Li
- School of Basic Medical Science, Southwest Medical University, Luzhou, China
| | - Xun Tang
- Sichuan SAFE Pharmaceutical Technology Company Limited, Chengdu, China
| | - Yinbing Zhang
- Sichuan SAFE Pharmaceutical Technology Company Limited, Chengdu, China
| | - Zhixiang Pan
- Department of Radiology, West China Hospital, Sichuan University, Chengdu, China
| | - Qiang Gao
- Department of Rehabilitation Medicine, West China Hospital, Sichuan University, Chengdu, China
| | - Zhihui Zhong
- Laboratory of Nonhuman Primate Disease Modeling Research, State Key Laboratory of Biotherapy, West China Hospital, Sichuan University, Chengdu, China
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15
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Zhao D, Ji J, Li S, Wu A. Skullcapflavone II protects neuronal damage in cerebral ischemic rats via inhibiting NF-ĸB and promoting angiogenesis. Microvasc Res 2022; 141:104318. [PMID: 35026288 DOI: 10.1016/j.mvr.2022.104318] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 01/05/2022] [Accepted: 01/05/2022] [Indexed: 12/17/2022]
Abstract
BACKGROUND Cerebral ischemia (CI) is considered as a main cause of cerebral stroke (CS) and poses significant risk to the mankind across the world. In the present study, we intended to investigate the protective effect of Skullcapflavone II (SCP) a flavonoid isolated from S. baicalensis on cerebral ischemia/reperfusion (I/R) injury. METHODS The middle cerebral artery occlusion (MCAO) and reperfusion was used to create ischemic stroke rat model. The rats were treated with (5, 10, and 15 mg/kg) SCP and after the end of the experiment the rats were sacrificed and various biochemical parameters were assed to determine the pharmacological action of SCP. RESULTS SCP dramatically decreases cerebral edema, infarct volume, and improves neurological manifestation as confirmed by reduced neurological deficit. SCP also improves the survivability of neurons as evidenced by H and E and Nissl staining. The level of oxidative stress in the cerebral cortex of the rats was found reduced after treatment with SCP, as confirmed by increase in GSH and SOD activity with reduction in MDA content. In addition, SCP attenuated inflammation via reducing the level of TNF-α, IL-1β and IL-6 in brain tissues of rats. SCP increases the expression of Bcl2, cleaved caspase-3 and -9, while decreasing Bax, and NF-ĸB/TLR4. It causes induction of angiogenesis as suggested by increased expression of VEGF, Ang-1 and Tie-2 in cerebral cortex of rat. CONCLUSIONS Our data determined that SCP may provide protective effect on the I/R-induced cerebral ischemia.
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Affiliation(s)
- Danpeng Zhao
- Department of Neurology, Ward 6, Zhengzhou Central Hospital Affiliated to Zhengzhou University, Zhengzhou City 450000, China
| | - Jinming Ji
- Department of Neurology, Binzhou People's Hospital, Binzhou, Shandong Province 256610, China
| | - Shanshan Li
- Department of Neurology, Binzhou People's Hospital, Binzhou, Shandong Province 256610, China
| | - Aimei Wu
- Department of Neurology, Xi'an Fengcheng Hospital, No.9 Fengcheng 3(rd) Road, Economic and Technological Development Zone, Xi'an, Shaanxi 710000, China.
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16
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Liu Z, Ma H, Guo ZN, Wang L, Qu Y, Fan L, Liu X, Liu J, Zhu Y, Yang Y. Impaired dynamic cerebral autoregulation is associated with the severity of neuroimaging features of cerebral small vessel disease. CNS Neurosci Ther 2021; 28:298-306. [PMID: 34894087 PMCID: PMC8739047 DOI: 10.1111/cns.13778] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2021] [Revised: 11/22/2021] [Accepted: 11/23/2021] [Indexed: 12/21/2022] Open
Abstract
Aims Cerebral small vessel disease (CSVD) is characterized by functional and structural changes in small vessels. We aimed to elucidate the relationship between dynamic cerebral autoregulation (dCA) and neuroimaging characteristics of CSVD. Methods A case‐control study was performed. Cerebral blood flow velocity (CBFV) of bilateral middle cerebral arteries and spontaneous arterial blood pressure were simultaneously recorded. Transfer function analysis was used to calculate dCA parameters (phase, gain, and the rate of recovery of CBFV [RoRc]). Neuroimaging characteristics of CSVD patients were evaluated, including lacunes, white matter hyperintensities (WMH), cerebral microbleeds (CMBs), perivascular spaces (PVS), and the total CSVD burden. Results Overall, 113 patients and 83 controls were enrolled. Compared with the control group, the phase at low frequency and the RoRc in CSVD patients were lower, and the gain at very low and low frequencies were higher, indicating bilaterally impaired dCA. Total CSVD burden, WMH (total, periventricular and deep), severe PVS, and lobar CMBs were independently correlated with the phase at low frequency. Conclusions Our findings suggested that dCA was compromised in CSVD patients, and some specific neuroimaging characteristics (the total CSVD burden, WMH, severe PVS and lobar CMBs) might indicate more severe dCA impairment in CSVD patients.
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Affiliation(s)
- Zhaojun Liu
- Stroke Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Hongyin Ma
- Stroke Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Zhen-Ni Guo
- Stroke Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Le Wang
- Stroke Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Yang Qu
- Stroke Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
| | - Lei Fan
- Department of Neurology, The First Hospital of Hebei North University, Zhangjiakou, China
| | - Xingliang Liu
- Department of Neurology, The First Hospital of Hebei North University, Zhangjiakou, China
| | - Jie Liu
- Department of Neurology, The People's Hospital of Lixin County, Haozhou, China
| | - Yuanyuan Zhu
- Department of Neurology, The People's Hospital of Lixin County, Haozhou, China
| | - Yi Yang
- Stroke Center & Clinical Trial and Research Center for Stroke, Department of Neurology, The First Hospital of Jilin University, Changchun, China.,China National Comprehensive Stroke Center, Changchun, China.,Jilin Provincial Key Laboratory of Cerebrovascular Disease, Changchun, China
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17
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Beishon LC, Minhas JS. Cerebral Autoregulation and Neurovascular Coupling in Acute and Chronic Stroke. Front Neurol 2021; 12:720770. [PMID: 34539560 PMCID: PMC8446264 DOI: 10.3389/fneur.2021.720770] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2021] [Accepted: 08/11/2021] [Indexed: 11/13/2022] Open
Affiliation(s)
- Lucy C. Beishon
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
| | - Jatinder S. Minhas
- Department of Cardiovascular Sciences, University of Leicester, Leicester, United Kingdom
- National Institute for Health Research (NIHR) Leicester Biomedical Research Centre, British Heart Foundation Cardiovascular Research Centre, Glenfield Hospital, Leicester, United Kingdom
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