1
|
Tsujita M, Melchior JT, Yokoyama S. Lipoprotein Particles in Cerebrospinal Fluid. Arterioscler Thromb Vasc Biol 2024; 44:1042-1052. [PMID: 38545782 DOI: 10.1161/atvbaha.123.318284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/26/2024]
Abstract
The brain is the most lipid-rich organ in the body, and the intricate interplay between lipid metabolism and pathologies associated with neurodegenerative disorders is being increasingly recognized. The brain is bathed in cerebrospinal fluid (CSF), which, like plasma, contains lipid-protein complexes called lipoproteins that are responsible for extracellular lipid transport. Multiple CSF lipoprotein populations exist, some of which are produced de novo in the central nervous system and others that appear to be generated from protein constituents that are produced in the periphery. These CSF lipoproteins are thought to play key roles in maintaining lipid homeostasis in the central nervous system, while little else is known due to their limited accessibility and their low abundance in CSF. Recent work has provided new insights into the compositional complexity of CSF lipoprotein families and their metabolism in cerebral circulation. The purpose of this review is to summarize our current state of knowledge on the composition, origin, and metabolism of CSF lipoproteins.
Collapse
Affiliation(s)
- Maki Tsujita
- Department of Biochemistry, Nagoya City University Graduate School of Medical Sciences, Japan (M.T.)
| | - John T Melchior
- Biological Sciences Division, Pacific Northwest National Laboratory, Richland, Washington (J.T.M.)
- Department of Pathology and Laboratory Medicine, Center for Lipid and Arteriosclerosis Science, University of Cincinnati, OH (J.T.M.)
- Department of Neurology, Oregon Health and Science University, Portland (J.T.M.)
| | - Shinji Yokoyama
- Department of Food and Nutritional Sciences, Chubu University, Kasugai, Japan (S.Y.)
| |
Collapse
|
2
|
Yokomizo S, Kopp T, Roessing M, Morita A, Lee S, Cho S, Ogawa E, Komai E, Inoue K, Fukushi M, Feil S, Kim HH, Bragin DE, Gerashchenko D, Huang PL, Kashiwagi S, Atochin DN. Near-Infrared II Photobiomodulation Preconditioning Ameliorates Stroke Injury via Phosphorylation of eNOS. Stroke 2024. [PMID: 38572660 DOI: 10.1161/strokeaha.123.045358] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 02/28/2024] [Indexed: 04/05/2024]
Abstract
BACKGROUND The current management of patients with stroke with intravenous thrombolysis and endovascular thrombectomy is effective only when it is timely performed on an appropriately selected but minor fraction of patients. The development of novel adjunctive therapy is highly desired to reduce morbidity and mortality with stroke. Since endothelial dysfunction is implicated in the pathogenesis of stroke and is featured with suppressed endothelial nitric oxide synthase (eNOS) with concomitant nitric oxide deficiency, restoring endothelial nitric oxide represents a promising approach to treating stroke injury. METHODS This is a preclinical proof-of-concept study to determine the therapeutic effect of transcranial treatment with a low-power near-infrared laser in a mouse model of ischemic stroke. The laser treatment was performed before the middle cerebral artery occlusion with a filament. To determine the involvement of eNOS phosphorylation, unphosphorylatable eNOS S1176A knock-in mice were used. Each measurement was analyzed by a 2-way ANOVA to assess the effect of the treatment on cerebral blood flow with laser Doppler flowmetry, eNOS phosphorylation by immunoblot analysis, and stroke outcomes by infarct volumes and neurological deficits. RESULTS Pretreatment with a 1064-nm laser at an irradiance of 50 mW/cm2 improved cerebral blood flow, eNOS phosphorylation, and stroke outcomes. CONCLUSIONS Near-infrared II photobiomodulation could offer a noninvasive and low-risk adjunctive therapy for stroke injury. This new modality using a physical parameter merits further consideration to develop innovative therapies to prevent and treat a wide array of cardiovascular diseases.
Collapse
Affiliation(s)
- Shinya Yokomizo
- Department of Neurology, MassGeneral Institute of Neurodegenerative Diseases, Massachusetts General Hospital and Harvard Medical School, Charlestown. (S.Y.)
- Department of Radiological Science, Tokyo Metropolitan University, Japan (S.Y., K.I., M.F.)
| | - Timo Kopp
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown. (T.K., M.R., A.M., E.K., P.L.H., D.N.A.)
- Interfaculty Institute of Biochemistry, University of Tübingen, Germany (T.K., M.R., S.F.)
| | - Malte Roessing
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown. (T.K., M.R., A.M., E.K., P.L.H., D.N.A.)
- Interfaculty Institute of Biochemistry, University of Tübingen, Germany (T.K., M.R., S.F.)
| | - Atsuyo Morita
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown. (T.K., M.R., A.M., E.K., P.L.H., D.N.A.)
| | - Seeun Lee
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown (S.L., S.C., H.-H.K.)
- School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea (S.L., S.C.)
| | - Suin Cho
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown (S.L., S.C., H.-H.K.)
- School of Korean Medicine, Pusan National University, Yangsan, Republic of Korea (S.L., S.C.)
| | - Emiyu Ogawa
- School of Allied Health Science, Kitasato University, Kanagawa, Japan (E.O.)
| | - Eri Komai
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown. (T.K., M.R., A.M., E.K., P.L.H., D.N.A.)
| | - Kazumasa Inoue
- Department of Radiological Science, Tokyo Metropolitan University, Japan (S.Y., K.I., M.F.)
| | - Masahiro Fukushi
- Department of Radiological Science, Tokyo Metropolitan University, Japan (S.Y., K.I., M.F.)
| | - Susanne Feil
- Interfaculty Institute of Biochemistry, University of Tübingen, Germany (T.K., M.R., S.F.)
| | - Hyung-Hwan Kim
- Stroke and Neurovascular Regulation Laboratory, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown (S.L., S.C., H.-H.K.)
| | - Denis E Bragin
- Lovelace Biomedical Research Institute, Albuquerque, NM (D.E.B.)
- Department of Neurology, The University of New Mexico School of Medicine, Albuquerque, NM (D.E.B.)
| | - Dmitry Gerashchenko
- Department of Psychiatry, Boston VA Medical Center West Roxbury, Veterans Affairs Boston Healthcare System and Harvard Medical School, MA (D.G., S.K., D.N.A.)
| | - Paul L Huang
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown. (T.K., M.R., A.M., E.K., P.L.H., D.N.A.)
| | - Satoshi Kashiwagi
- Gordon Center for Medical Imaging, Department of Radiology, Massachusetts General Hospital and Harvard Medical School, Charlestown. (S.K.)
- Department of Psychiatry, Boston VA Medical Center West Roxbury, Veterans Affairs Boston Healthcare System and Harvard Medical School, MA (D.G., S.K., D.N.A.)
| | - Dmitriy N Atochin
- Cardiovascular Research Center, Department of Medicine, Massachusetts General Hospital and Harvard Medical School, Charlestown. (T.K., M.R., A.M., E.K., P.L.H., D.N.A.)
- Department of Psychiatry, Boston VA Medical Center West Roxbury, Veterans Affairs Boston Healthcare System and Harvard Medical School, MA (D.G., S.K., D.N.A.)
| |
Collapse
|
3
|
Marquez-Romero JM, García-Perales C, García-Arellano M, Ortíz MS, Pérez-Malagón CD, Huerta-Franco MR, Vargas-Luna FM. Capsaicin for Cerebral Perfusion Augmentation: A Randomized Open-Label Trial. Stroke 2024; 55:e112-e114. [PMID: 38456262 DOI: 10.1161/strokeaha.123.046045] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/09/2024]
Affiliation(s)
- Juan Manuel Marquez-Romero
- Departamento de Neurología, HGZ 2, Instituto Mexicano del Seguro Social (IMSS), Aguascalientes, Mexico (J.M.M.-R., C.D.P.-M.)
| | - Claudio García-Perales
- Departamento de Neurología, HGZ 50, Instituto Mexicano del Seguro Social (IMSS), San Luis Potosí, Mexico (C.G.-P.)
| | - Maricela García-Arellano
- Departmento de Terapia Intensiva Pediátrica, Centenario Hospital "Miguel Hidalgo," Aguascalientes, Mexico (M.G.-A., M.S.O.)
| | - María Soledad Ortíz
- Departmento de Terapia Intensiva Pediátrica, Centenario Hospital "Miguel Hidalgo," Aguascalientes, Mexico (M.G.-A., M.S.O.)
| | - Carlos David Pérez-Malagón
- Departamento de Neurología, HGZ 2, Instituto Mexicano del Seguro Social (IMSS), Aguascalientes, Mexico (J.M.M.-R., C.D.P.-M.)
| | | | | |
Collapse
|
4
|
Webb AJ, Klerman EB, Mandeville ET. Circadian and Diurnal Regulation of Cerebral Blood Flow. Circ Res 2024; 134:695-710. [PMID: 38484025 PMCID: PMC10942227 DOI: 10.1161/circresaha.123.323049] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2023] [Revised: 01/30/2024] [Accepted: 02/07/2024] [Indexed: 03/17/2024]
Abstract
Circadian and diurnal variation in cerebral blood flow directly contributes to the diurnal variation in the risk of stroke, either through factors that trigger stroke or due to impaired compensatory mechanisms. Cerebral blood flow results from the integration of systemic hemodynamics, including heart rate, cardiac output, and blood pressure, with cerebrovascular regulatory mechanisms, including cerebrovascular reactivity, autoregulation, and neurovascular coupling. We review the evidence for the circadian and diurnal variation in each of these mechanisms and their integration, from the detailed evidence for mechanisms underlying the nocturnal nadir and morning surge in blood pressure to identifying limited available evidence for circadian and diurnal variation in cerebrovascular compensatory mechanisms. We, thus, identify key systemic hemodynamic factors related to the diurnal variation in the risk of stroke but particularly identify the need for further research focused on cerebrovascular regulatory mechanisms.
Collapse
Affiliation(s)
- Alastair J.S. Webb
- Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom (A.J.S.W.)
| | - Elizabeth B. Klerman
- Department of Clinical Neurosciences, Wolfson Centre for Prevention of Stroke and Dementia, University of Oxford, United Kingdom (A.J.S.W.)
- Department of Neurology, Massachusetts General Hospital, Boston (E.B.K.)
- Division of Sleep and Circadian Disorders, Department of Medicine, Brigham and Women’s Hospital, Boston, MA (E.B.K.)
- Division of Sleep Medicine, Harvard Medical School, Boston, MA (E.B.K.)
| | - Emiri T. Mandeville
- Departments of Radiology and Neurology, Neuroprotection Research Laboratories, Massachusetts General Hospital, Harvard Medical School, Boston (E.T.M.)
| |
Collapse
|
5
|
Abstract
Hypertension is extremely common, affecting approximately 1 in every 2 adults globally. Chronic hypertension is the leading modifiable risk factor for cardiovascular disease and premature mortality worldwide. Despite considerable efforts to define mechanisms that underlie hypertension, a potentially major component of the disease, the role of circadian biology has been relatively overlooked in both preclinical models and humans. Although the presence of daily and circadian patterns has been observed from the level of the genome to the whole organism, the functional and structural impact of biological rhythms, including mechanisms such as circadian misalignment, remains relatively poorly defined. Here, we review the impact of daily rhythms and circadian systems in regulating blood pressure and the onset, progression, and consequences of hypertension. There is an emphasis on the impact of circadian biology in relation to vascular disease and end-organ effects that, individually or in combination, contribute to complex phenotypes such as cognitive decline and the loss of cardiac and brain health. Despite effective treatment options for some individuals, control of blood pressure remains inadequate in a substantial portion of the hypertensive population. Greater insight into circadian biology may form a foundation for novel and more widely effective molecular therapies or interventions to help in the prevention, treatment, and management of hypertension and its related pathophysiology.
Collapse
Affiliation(s)
- Frank M. Faraci
- Department of Internal Medicine, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
- Department of Neuroscience and Pharmacology, Francois M. Abboud Cardiovascular Center, Carver College of Medicine, University of Iowa, Iowa City, IA 52242-1081
| | - Frank A.J.L. Scheer
- Division of Sleep Medicine, Harvard Medical School, Brigham and Women's Hospital, Boston, Massachusetts, 02115
- Medical Chronobiology Program, Division of Sleep and Circadian Disorders, Departments of Medicine and Neurology, Brigham and Women's Hospital, Boston, Massachusetts, 02115
| |
Collapse
|
6
|
Zhang W, Jin HT, Wang F, Zhang JL, Bao Y, Wang S. A randomized controlled study investigating the efficacy of electro-acupuncture and exercise-based swallowing rehabilitation for post-stroke dysphagia: Impacts on brainstem auditory evoked potentials and cerebral blood flow. Medicine (Baltimore) 2024; 103:e37464. [PMID: 38489710 PMCID: PMC10939640 DOI: 10.1097/md.0000000000037464] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Revised: 02/07/2024] [Accepted: 02/12/2024] [Indexed: 03/17/2024] Open
Abstract
BACKGROUND Swallowing rehabilitation behavioral therapy and traditional Chinese acupuncture therapy are widely used in the treatment of post-stroke dysphagia (PSD). This study investigated the therapeutic effect of electro-acupuncture combined with exercise-based swallowing rehabilitation on PSD and its effect on brainstem auditory evoked potential (BAEP) and cerebral blood flow. METHODS The 120 PSD patients were divided into 2 groups (n = 60 each) by simple random grouping method, that is, an experimental and control group, receiving routine swallowing training, or additional intervention with electro-acupuncture at a frequency of 5 times/week. Data in swallowing function, BAEP, and cerebrovascular color Doppler ultrasound parameters were collected before treatment, as well as after treatment. An intergroup comparison was conducted using an independent sample t-test, and an intra-group comparison was conducted among different time points using a paired t-test. The data were analyzed using the SPSS Statistics 22.0 software; P < .05 was considered statistically significant. RESULTS The therapeutic effects were significantly better in the experimental group compared with the control group (P < .05). The standard swallowing function assessment scores were significantly lower in both groups after treatment (P < .05), and the score in the observation group was lower than in the control group (P < .05). The peak latency of BAEP waves III and IV, and the inter-peak latency between peaks III to V and I to V in the 2 groups changed significantly (P < .05). The peak systolic velocity (PSV), end-diastolic velocity (EDV), and mean velocity (MV) were significantly increased in both groups after treatment (P < .05). The pulsatility index decreased significantly in both groups (P < .05), and the PSV, EDV, and MV were higher in the experimental group than in the control group (P < .05). CONCLUSION Electro-acupuncture, combined with swallowing training in the treatment of Post-stroke Dysphagia, effectively improved cerebral microcirculation and conduction velocity, enhanced the motor function of swallowing muscles, and promoted the recovery of swallowing function.
Collapse
Affiliation(s)
- Wen Zhang
- Department of Encephalopathy, The Traditional Chinese Medicine Hospital of Wuhan, Jiang’an, Wuhan, Hubei, China
| | - Hai-Tao Jin
- Department of Encephalopathy, The Traditional Chinese Medicine Hospital of Wuhan, Jiang’an, Wuhan, Hubei, China
| | - Fei Wang
- Department of Encephalopathy, The Traditional Chinese Medicine Hospital of Wuhan, Jiang’an, Wuhan, Hubei, China
| | - Jing-Lan Zhang
- Department of Encephalopathy, The Traditional Chinese Medicine Hospital of Wuhan, Jiang’an, Wuhan, Hubei, China
| | - Yuan Bao
- Department of Network Medicine, The Central Hospital of Wuhan, Jiang’an, Wuhan, Hubei, China
| | - Song Wang
- Department of Massage, The Traditional Chinese Medicine Hospital of Wuhan, Jiang’an, Wuhan, Hubei, China
| |
Collapse
|
7
|
Koneru M, Hoseinyazdi M, Lakhani DA, Greene C, Copeland K, Wang R, Xu R, Luna L, Caplan JM, Dmytriw AA, Guenego A, Heit JJ, Albers GW, Wintermark M, Gonzalez LF, Urrutia VC, Huang J, Nael K, Leigh R, Marsh EB, Hillis AE, Llinas RH, Yedavalli VS. Redefining CT perfusion-based ischemic core estimates for the ghost core in early time window stroke. J Neuroimaging 2024; 34:249-256. [PMID: 38146065 DOI: 10.1111/jon.13180] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2023] [Revised: 12/05/2023] [Accepted: 12/05/2023] [Indexed: 12/27/2023] Open
Abstract
BACKGROUND AND PURPOSE In large vessel occlusion (LVO) stroke patients, relative cerebral blood flow (rCBF)<30% volume thresholds are commonly used in treatment decisions. In the early time window, nearly infarcted but salvageable tissue volumes may lead to pretreatment overestimates of infarct volume, and thus potentially exclude patients who may otherwise benefit from intervention. Our multisite analysis aims to explore the strength of relationships between widely used pretreatment CT parameters and clinical outcomes for early window stroke patients. METHODS Patients from two sites in a prospective registry were analyzed. Patients with LVOs, presenting within 3 hours of last known well, and who were successfully reperfused were included. Primary short-term neurological outcome was percent National Institutes of Health Stroke Scale (NIHSS) change from admission to discharge. Secondary long-term outcome was 90-day modified Rankin score. Spearman's correlations were performed. Significance was attributed to p-value ≤.05. RESULTS Among 73 patients, median age was 66 (interquartile range 54-76) years. Among all pretreatment imaging parameters, rCBF<30%, rCBF<34%, and rCBF<38% volumes were significantly, inversely correlated with percentage NIHSS change (p<.048). No other parameters significantly correlated with outcomes. CONCLUSIONS Our multisite analysis shows that favorable short-term neurological recovery was significantly correlated with rCBF volumes in the early time window. However, modest strength of correlations provides supportive evidence that the applicability of general ischemic core estimate thresholds in this subpopulation is limited. Our results support future larger-scale efforts to liberalize or reevaluate current rCBF parameter thresholds guiding treatment decisions for early time window stroke patients.
Collapse
Affiliation(s)
- Manisha Koneru
- Cooper Medical School of Rowan University, Camden, New Jersey, USA
| | | | | | - Cynthia Greene
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Richard Wang
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Risheng Xu
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Licia Luna
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Adam A Dmytriw
- Massachusetts General Hospital, Boston, Massachusetts, USA
| | - Adrien Guenego
- Université Libre De Bruxelles Hospital Erasme, Brussels, Belgium
| | - Jeremy J Heit
- Stanford University School of Medicine, Stanford, California, USA
| | - Gregory W Albers
- Stanford University School of Medicine, Stanford, California, USA
| | - Max Wintermark
- University of Texas MD Anderson Center, Houston, Texas, USA
| | | | | | - Judy Huang
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | - Kambiz Nael
- David Geffen School of Medicine at UCLA, Los Angeles, California, USA
| | - Richard Leigh
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | - Argye E Hillis
- Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | |
Collapse
|
8
|
Huang JA, Lin CH, Wu MJ, Chen YH, Chang KC, Hou CW. Ten-year follow-up investigation of stroke risk in systemic lupus erythematosus. Stroke Vasc Neurol 2024; 9:1-7. [PMID: 37169398 PMCID: PMC10956114 DOI: 10.1136/svn-2022-001499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2022] [Accepted: 05/02/2023] [Indexed: 05/13/2023] Open
Abstract
BACKGROUND AND PURPOSE To analyse the long-term risk of ischaemic stroke and the clinical effects of antithrombotics on the risk of haemorrhagic stroke in patients with systemic lupus erythematosus (SLE). METHODS A retrospective cohort study was conducted using a population-based database taken from Taiwan National Health Insurance Research Database. Patients with SLE between 2000 and 2008 were registered and matched with two controls by the index date, age, gender and Charlson Comorbidity Index (CCI). These subjects were followed until either stroke event or 31 December 2013. Adjusted HRs (aHRs) for strokes were estimated with Cox regression models, and the cumulative incidence of ischaemic stroke was analysed by log-rank test and Kaplan-Meier survival analysis. RESULTS In total, 8310 patients with SLE and 16 620 patients without SLE were included. In general, patients with SLE had higher rates of ischaemic stroke (5.4% vs 3.3%) and haemorrhagic stroke (1.5% vs 0.6%) than in controls. In multivariate analysis adjusted to age, gender, CCI, urbanisation level and antithrombotics uses, aHRs of all strokes, ischaemic stroke and haemorrhagic stroke were 1.73 (95% CI: 1.54 to 1.94), 1.65 (95% CI: 1.45 to 1.87) and 2.24 (95% CI: 1.71 to 2.95), respectively, in patients with SLE. Patients with SLE were significantly more likely to suffer ischaemic stroke than patients without SLE, even 10 years after SLE diagnosis (6.12% vs 3.50%, p<0.001). Antiplatelet use increased the risk of haemorrhagic stroke in SLE group (aHR=1.74, 95% CI: 1.18 to 2.57). CONCLUSIONS Patients with SLE are at greater risk of developing ischaemic stroke that lasts for 10 years. Antiplatelets should be carefully administered to prevent cardiovascular events in patients with SLE due to the risk of haemorrhagic stroke.
Collapse
Affiliation(s)
- Jin-An Huang
- Division of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
- Department of Health Business Administration, Hungkuang University, Taichung,Taiwan
| | - Ching-Heng Lin
- Department of Medical Research, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Ming-Ju Wu
- Division of Nephrology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, Chung Shan Medical University, Taichung, Taiwan
- College of Medicine, National Chung Hsing University, Taichung, Taiwan
| | - Yi-Hsing Chen
- Division of Allergy, Immunology and Rheumatology, Department of Internal Medicine, Taichung Veterans General Hospital, Taichung, Taiwan
- School of Medicine, National Yang-Ming Chiao Tung University, Taichung, Taiwan
| | - Kuo-Cheng Chang
- Division of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| | - Chung-Wei Hou
- Division of Neurology, Neurological Institute, Taichung Veterans General Hospital, Taichung, Taiwan
| |
Collapse
|
9
|
Winkelmeier L, Heit JJ, Broocks G, Prüter J, Heitkamp C, Schell M, Albers GW, Lansberg MG, Wintermark M, Kemmling A, Stracke CP, Guenego A, Paech D, Fiehler J, Faizy TD. Association between occlusion location, net water uptake and ischemic lesion growth in large vessel anterior circulation strokes. J Cereb Blood Flow Metab 2024:271678X241232193. [PMID: 38329032 DOI: 10.1177/0271678x241232193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/09/2024]
Abstract
Ischemic lesion net water uptake (NWU) represents a quantitative imaging biomarker for cerebral edema in acute ischemic stroke. Data on NWU for distinct occlusion locations remain scarce, but might help to improve the prognostic value of NWU. In this retrospective multicenter cohort study, we compared NWU between patients with proximal large vessel occlusion (pLVO; ICA or proximal M1) and distal large vessel occlusion (dLVO; distal M1 or M2). NWU was quantified by densitometric measurements of the early ischemic region. Arterial collateral status was assessed using the Maas scale. Regression analysis was used to investigate the relationship between occlusion location, NWU and ischemic lesion growth. A total of 685 patients met inclusion criteria. Early ischemic lesion NWU was higher in patients with pLVO compared with dLVO (7.7% vs 3.9%, P < .001). The relationship between occlusion location and NWU was partially mediated by arterial collateral status. NWU was associated with absolute ischemic lesion growth between admission and follow-up imaging (β estimate, 5.50, 95% CI, 3.81-7.19, P < .001). This study establishes a framework for the relationship between occlusion location, arterial collateral status, early ischemic lesion NWU and ischemic lesion growth. Future prognostic thresholds for NWU might be optimized by adjusting for the occlusion location.
Collapse
Affiliation(s)
- Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeremy J Heit
- Department of Neuroradiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Prüter
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Heitkamp
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maximilian Schell
- Department of Neurology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregory W Albers
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten G Lansberg
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, Texas, USA
| | - André Kemmling
- Department of Neuroradiology, University Marburg, Marburg, Germany
| | | | - Adrien Guenego
- Department of Neuroradiology, Erasme Medical Center, Brussels, Belgium
| | - Daniel Paech
- Clinic for Neuroradiology, University Hospital Bonn, Bonn, Germany
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
10
|
Schaich CL, Hughes TM, Kitzman DW, Jung Y, Chen H, Nicklas BJ, Houston DK, Brubaker P, Molina AJ, Hugenschmidt CE. Neurocognitive Impairments and Their Improvement Following Exercise and Dietary Interventions in Older Patients With Heart Failure With Preserved Ejection Fraction. Circ Heart Fail 2024; 17:e011134. [PMID: 38037817 PMCID: PMC10842717 DOI: 10.1161/circheartfailure.123.011134] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2023]
Affiliation(s)
- Christopher L. Schaich
- Department of Surgery, Hypertension and Vascular Research Center, Wake Forest University School of Medicine, Winston-Salem, NC
| | - Timothy M. Hughes
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
- Department of Epidemiology and Prevention, Wake Forest University School of Medicine
| | - Dalane W. Kitzman
- Department of Internal Medicine, Section on Cardiovascular Medicine, Wake Forest University School of Medicine
| | - Youngkyoo Jung
- Department of Radiology, UC Davis School of Medicine, Sacramento, CA
| | - Haiying Chen
- Department of Biostatistics and Data Science, Wake Forest University School of Medicine
| | - Barbara J. Nicklas
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
| | - Denise K. Houston
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
| | - Peter Brubaker
- Department of Health and Exercise Science, Wake Forest University, Winston-Salem, NC
| | - Anthony J.A. Molina
- Division of Geriatrics, Gerontology and Palliative Care, UC San Diego School of Medicine, La Jolla, CA
| | - Christina E. Hugenschmidt
- Department of Internal Medicine, Section on Gerontology and Geriatric Medicine, Wake Forest University School of Medicine
| |
Collapse
|
11
|
Sekiguchi H, Kikuchi N, Ishida I, Sekiguchi N, Nishimura K, Shiga T, Kawana M, Hagiwara N, Takemura Y, Yamaguchi J. Direct Link Between Cardiac Failure and Global Cerebral Atrophy in a Young Adult: A Case Report on Reduced Cerebral Artery Blood Flow. Am J Case Rep 2023; 24:e940892. [PMID: 37943737 PMCID: PMC10643886 DOI: 10.12659/ajcr.940892] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2023] [Revised: 09/28/2023] [Accepted: 09/30/2023] [Indexed: 11/12/2023]
Abstract
BACKGROUND Heart failure is associated with structural brain abnormalities, including atrophy of multiple brain regions. Previous studies have reported brain atrophy in middle-aged patients with systolic heart failure. In this report, we present the case of a 21-year-old woman with idiopathic dilated cardiomyopathy, cardiac failure, and global cerebral atrophy due to reduced cerebral artery blood flow. We also discuss the impact of brain atrophy in this young adult patient with severe heart failure and no risk factors for atherosclerosis. CASE REPORT A 21-year-old woman with dyspnea and leg edema was admitted to our hospital. After several examinations, an endomyocardial biopsy led to a diagnosis of idiopathic dilated cardiomyopathy, and transthoracic ultrasound cardiography revealed that her left ventricular ejection fraction was 36%. One year after the first hospitalization, her heart failure was classified as New York Heart Association Class III. Magnetic resonance imaging showed severe global brain atrophy, and single-photon emission computed tomography combined with brain computed tomography showed reduced blood flow to the entire brain. She had no risk factors for atherosclerosis and no atherosclerotic changes to her brain or carotid arteries, but her neuropsychological and neurological findings indicated more pronounced brain and cognitive dysfunction. CONCLUSIONS This young adult patient with idiopathic dilated cardiomyopathy, cardiac failure, and global cerebral atrophy showed reduced cerebral artery blood flow and cognitive impairment. The findings of this report indicate that low cardiac output may directly cause brain atrophy in patients with systolic heart failure.
Collapse
Affiliation(s)
- Haruki Sekiguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Comprehensive Sleep Medicine, Tokyo Women’s Medical University, Tokyo, Japan
- National Hospital Organization Yokohama Medical Center, Yokohama, Kanagawa, Japan
- National Hospital Organization Kyoto Medical Center, Kyoto, Japan
| | - Noriko Kikuchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Issei Ishida
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Naoki Sekiguchi
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
- Cosmetic Dermatology, UB CLINIC Shinjyuku, Tokyo, Japan
| | - Katsuji Nishimura
- Department of Psychiatry, Tokyo Women’s Medical University, Tokyo, Japan
| | - Tsuyoshi Shiga
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of Clinical Pharmacology and Therapeutics, The Jikei University School of Medicine, Tokyo, Japan
| | - Masatoshi Kawana
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| | - Yousuke Takemura
- Department of General Medicine, Tokyo Women’s Medical University, Tokyo, Japan
| | - Junichi Yamaguchi
- Department of Cardiology, Tokyo Women’s Medical University, Tokyo, Japan
| |
Collapse
|
12
|
Sleight E, Stringer MS, Clancy U, Arteaga C, Jaime Garcia D, Hewins W, Jochems AC, Hamilton OK, Manning C, Morgan AG, Locherty R, Cheng Y, Liu X, Zhang J, Hamilton I, Jardine C, Brown R, Sakka E, Kampaite A, Wiseman S, Valdés-Hernández MC, Chappell FM, Doubal FN, Marshall I, Thrippleton MJ, Wardlaw JM. Cerebrovascular Reactivity in Patients With Small Vessel Disease: A Cross-Sectional Study. Stroke 2023; 54:2776-2784. [PMID: 37814956 PMCID: PMC10589433 DOI: 10.1161/strokeaha.123.042656] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2023] [Revised: 09/06/2023] [Accepted: 09/19/2023] [Indexed: 10/11/2023]
Abstract
BACKGROUND Cerebrovascular reactivity (CVR) is inversely related to white matter hyperintensity severity, a marker of cerebral small vessel disease (SVD). Less is known about the relationship between CVR and other SVD imaging features or cognition. We aimed to investigate these cross-sectional relationships. METHODS Between 2018 and 2021 in Edinburgh, we recruited patients presenting with lacunar or cortical ischemic stroke, whom we characterized for SVD features. We measured CVR in subcortical gray matter, normal-appearing white matter, and white matter hyperintensity using 3T magnetic resonance imaging. We assessed cognition using Montreal Cognitive Assessment. Statistical analyses included linear regression models with CVR as outcome, adjusted for age, sex, and vascular risk factors. We reported regression coefficients with 95% CIs. RESULTS Of 208 patients, 182 had processable CVR data sets (median age, 68.2 years; 68% men). Although the strength of association depended on tissue type, lower CVR in normal-appearing tissues and white matter hyperintensity was associated with larger white matter hyperintensity volume (BNAWM=-0.0073 [95% CI, -0.0133 to -0.0014] %/mm Hg per 10-fold increase in percentage intracranial volume), more lacunes (BNAWM=-0.00129 [95% CI, -0.00215 to -0.00043] %/mm Hg per lacune), more microbleeds (BNAWM=-0.00083 [95% CI, -0.00130 to -0.00036] %/mm Hg per microbleed), higher deep atrophy score (BNAWM=-0.00218 [95% CI, -0.00417 to -0.00020] %/mm Hg per score point increase), higher perivascular space score (BNAWM=-0.0034 [95% CI, -0.0066 to -0.0002] %/mm Hg per score point increase in basal ganglia), and higher SVD score (BNAWM=-0.0048 [95% CI, -0.0075 to -0.0021] %/mm Hg per score point increase). Lower CVR in normal-appearing tissues was related to lower Montreal Cognitive Assessment without reaching convention statistical significance (BNAWM=0.00065 [95% CI, -0.00007 to 0.00137] %/mm Hg per score point increase). CONCLUSIONS Lower CVR in patients with SVD was related to more severe SVD burden and worse cognition in this cross-sectional analysis. Longitudinal analysis will help determine whether lower CVR predicts worsening SVD severity or vice versa. REGISTRATION URL: https://www.isrctn.com; Unique identifier: ISRCTN12113543.
Collapse
Affiliation(s)
- Emilie Sleight
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Michael S. Stringer
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Una Clancy
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Carmen Arteaga
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Daniela Jaime Garcia
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Will Hewins
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Angela C.C. Jochems
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Olivia K.L. Hamilton
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Cameron Manning
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Alasdair G. Morgan
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Rachel Locherty
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Yajun Cheng
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- Department of Neurology, West China Hospital of Sichuan University, Chengdu (Y.C.)
| | - Xiaodi Liu
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- Department of Medicine, University of Hong Kong (X.L.)
| | - Junfang Zhang
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- Department of Neurology, Shanghai General Hospital, Shanghai Jiao Tong University School of Medicine, China (J.Z.)
| | - Iona Hamilton
- Edinburgh Imaging Facility RIE (I.H., C.J., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Charlotte Jardine
- Edinburgh Imaging Facility RIE (I.H., C.J., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Rosalind Brown
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Eleni Sakka
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Agniete Kampaite
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Stewart Wiseman
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Maria C. Valdés-Hernández
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Francesca M. Chappell
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Fergus N. Doubal
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Ian Marshall
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Michael J. Thrippleton
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- Edinburgh Imaging Facility RIE (I.H., C.J., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| | - Joanna M. Wardlaw
- Centre for Clinical Brain Sciences (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- UK Dementia Research Institute (E. Sleight, M.S.S., U.C., C.A., D.J.G., W.H., A.C.C.J., O.K.L.H., C.M., A.G.M., R.L., Y.C., X.L., J.Z., R.B., E. Sakka, A.K., S.W., M.C.V.-H., F.M.C., F.N.D., I.M., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
- Edinburgh Imaging Facility RIE (I.H., C.J., M.J.T., J.M.W.), University of Edinburgh, United Kingdom
| |
Collapse
|
13
|
Rubinelli L, Garcia-Bonilla L, Sasset L, Cantalupo A, Goya B, Ip J, Anrather J, Iadecola C, Faraco G, Di Lorenzo A. Essential Role of Endothelial Sphingolipid Biosynthesis in Cerebrovascular Homeostasis. Circ Res 2023; 133:880-882. [PMID: 37791485 PMCID: PMC10615788 DOI: 10.1161/circresaha.123.323183] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/05/2023]
Affiliation(s)
- Luisa Rubinelli
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Lidia Garcia-Bonilla
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Linda Sasset
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Anna Cantalupo
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Benjamin Goya
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - James Ip
- Division of Cardiology, Department of Medicine, Weill Cornell Medicine, New York Presbyterian Hospital, New York, NY, USA
| | - Josef Anrather
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Costantino Iadecola
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Giuseppe Faraco
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| | - Annarita Di Lorenzo
- Department of Pathology and Laboratory Medicine, Cardiovascular Research Institute, Weill Cornell Medicine, New York, NY, USA
- Feil Family Brain and Mind Research Institute, Weill Cornell Medicine, New York, NY, USA
| |
Collapse
|
14
|
Abedi A, Sizdahkhani S, Choi W, Nguyen VN, Rennert RC, Russin JJ. Cilostazol for the management of moyamoya disease: a systematic review of the early evidence, efficacy, safety, and future directions. Neurosurg Focus 2023; 55:E9. [PMID: 37778042 DOI: 10.3171/2023.7.focus23327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 07/28/2023] [Indexed: 10/03/2023]
Abstract
Surgical revascularization remains the standard treatment for symptomatic moyamoya disease (MMD). As with any major surgical treatment, revascularization is associated with risks and limitations, denoting the need for noninvasive treatments to improve ischemic symptoms and prevent strokes. Cilostazol is a selective phosphodiesterase III inhibitor with antiplatelet, antithrombotic, and vasodilatory effects commonly used in peripheral vascular disease. Clinical studies assessing the efficacy of cilostazol in the management of stroke and MMD were recently reported, although a comprehensive assessment of the overall evidence is lacking. A systematic scoping review was conducted to assess the early evidence on cilostazol administration in patients with MMD. The inclusion criteria encompassed original human studies primarily focused on cilostazol's safety, efficacy, or utilization in managing MMD patients. A search of the PubMed database was conducted in June 2023, yielding 5 peer-reviewed publications that satisfied the inclusion criteria and were subjected to narrative synthesis. Risk of bias assessment was not applicable due to the scoping nature of this review. East Asian studies demonstrate increasing rates of cilostazol prescriptions for patients with MMD. In a large population-based study, cilostazol was compared to other antiplatelet medications and yielded the largest decrease in mortality among patients with newly diagnosed MMD. Other studies reported significant improvements in cerebral blood flow and cognitive function, which were deemed to be independent of one another. There are limited data on the safety profile of cilostazol in the MMD population, although the evidence derived from various studies performed in the general stroke population can likely provide insights into its potential utility in MMD patients. Cilostazol targets several critical pathways involved in the pathophysiology of MMD. The evidence corroborates the potential benefits of cilostazol for the management of MMD, although these findings should be interpreted with caution due to the small number of studies and lack of randomized trials. Subgroups of patients need to be identified who can safely undergo medical management in lieu of revascularization surgery or to improve surgical outcomes. Additional studies are needed to assess the efficacy and safety of cilostazol therapy, especially in Western populations.
Collapse
Affiliation(s)
- Aidin Abedi
- 1USC Neurorestoration Center and
- 2Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Saman Sizdahkhani
- 2Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Wooseong Choi
- 2Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Vincent N Nguyen
- 2Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Robert C Rennert
- 2Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| | - Jonathan J Russin
- 1USC Neurorestoration Center and
- 2Department of Neurological Surgery, Keck School of Medicine, University of Southern California, Los Angeles, California
| |
Collapse
|
15
|
Heitkamp C, Winkelmeier L, Heit JJ, Flottmann F, Thaler C, Kniep H, Broocks G, Meyer L, Geest V, Albers GW, Lansberg MG, Fiehler J, Faizy TD. The negative effect of aging on cerebral venous outflow in acute ischemic stroke. J Cereb Blood Flow Metab 2023; 43:1648-1655. [PMID: 37254736 PMCID: PMC10581231 DOI: 10.1177/0271678x231179558] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/26/2023] [Revised: 04/21/2023] [Accepted: 04/24/2023] [Indexed: 06/01/2023]
Abstract
Cortical venous outflow (VO) represents an imaging biomarker of increasing interest in patients with acute ischemic stroke due to large vessel occlusion (AIS-LVO). We conducted a retrospective multicenter cohort study to investigate the effect of aging on VO. A total of 784 patients met the inclusion criteria. Cortical Vein Opacification Score (COVES) was used to assess VO profiles on admission CT angiography. Cerebral microperfusion was determined using the hypoperfusion intensity ratio (HIR) derived from perfusion imaging. Arterial collaterals were assessed using the Tan scale. Multivariable regression analysis was performed to identify independent determinants of VO, HIR and arterial collaterals. In multivariable regression, higher age correlated with worse VO (adjusted odds ratio [95% CI]; 0.83 [0.73-0.95]; P = 0.006) and poorer HIR (β coefficient [95% CI], 0.014 [0.005-0.024]; P = 0.002). The negative effect of higher age on VO was mediated by the extent of HIR (17.3%). We conclude that higher age was associated with worse VO in AIS-LVO, partially explained by the extent of HIR reflecting cerebral microperfusion. Our study underlines the need to assess collateral blood flow beyond the arterial system and provides valuable insights into deteriorated cerebral blood supply in elderly AIS-LVO patients.
Collapse
Affiliation(s)
- Christian Heitkamp
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Fabian Flottmann
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Christian Thaler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Vincent Geest
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Gregory W Albers
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Maarten G Lansberg
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
16
|
Tian Y, Cai X, Zhou Y, Jin A, Wang S, Yang Y, Mei L, Jing J, Li S, Meng X, Wei T, Liu T, Wang Y, Pan Y, Wang Y. Impaired glymphatic system as evidenced by low diffusivity along perivascular spaces is associated with cerebral small vessel disease: a population-based study. Stroke Vasc Neurol 2023; 8:413-423. [PMID: 37045543 PMCID: PMC10647865 DOI: 10.1136/svn-2022-002191] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Accepted: 03/10/2023] [Indexed: 04/14/2023] Open
Abstract
OBJECTIVE This study aims to investigate the associations of glymphatic system with the presence, severity and neuroimaging phenotypes of cerebral small vessel disease (CSVD) in a community-based population. METHOD This report included 2219 community-dwelling people aged 50-75 years who participated in the PolyvasculaR Evaluation for Cognitive Impairment and vaScular Events cohort. The diffusivity along perivascular spaces based on diffusion tensor imaging (DTI-ALPS index) was measured to assess glymphatic pathway. The presence and severity of CSVD were estimated using a CSVD score (points from 0 to 4) and a modified CSVD score (points from 0 to 4), which were driven by 4 neuroimaging features of CSVD, including white matter hyperintensity (WMH), enlarged perivascular spaces (EPVS), lacunes, cerebral microbleeds. Brain atrophy (BA) was also evaluated. Binary or ordinal logistic regression analyses were carried out to investigate the relationships of DTI-ALPS index with CSVD. RESULT The mean age was 61.3 (SD 6.6) years, and 1019 (45.9%) participants were men. The average DTI-ALPS index was 1.67±0.14. Individuals in the first quartile (Q1) of the DTI-ALPS index had higher risks of the presence of CSVD (OR 1.77, 95% CI 1.33 to 2.35, p<0.001), modified presence of CSVD (odds ratio (OR) 1.80, 95% CI 1.38 to 2.34, p<0.001), total burden of CSVD (common OR (cOR) 1.89, 95% CI 1.43 to 2.49, p<0.001) and modified total burden of CSVD (cOR 1.95, 95% CI 1.51 to 2.50, p<0.001) compared with those in the fourth quartile (Q4). Additionally, individuals in Q1 of the DTI-ALPS index had increased risks of WMH burden, modified WMH burden, lacunes, basal ganglia-EPVS and BA (all p<0.05). CONCLUSION A lower DTI-ALPS index underlay the presence, severity and typical neuroimaging markers of CSVD, implying that glymphatic impairment may interact with CSVD-related pathology in the general ageing population. TRIAL REGISTRATION NUMBER NCT03178448.
Collapse
Affiliation(s)
- Yu Tian
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Xueli Cai
- Department of Neurology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Yijun Zhou
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Aoming Jin
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Suying Wang
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Yingying Yang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Lerong Mei
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Jing Jing
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Shan Li
- Cerebrovascular Research Lab, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Xia Meng
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Tiemin Wei
- Department of Cardiology, The Fifth Affiliated Hospital of Wenzhou Medical University, Lishui, Zhejiang, China
| | - Tao Liu
- Beijing Advanced Innovation Center for Biomedical Engineering, School of Biological Science and Medical Engineering, Beihang University, Beijing, China
| | - Yongjun Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yuesong Pan
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| | - Yilong Wang
- Department of Neurology, Beijing Tiantan Hospital, Beijing, China
- China National Clinical Research Center for Neurological Diseases, Beijing, China
| |
Collapse
|
17
|
Svedung Wettervik T, Fahlström M, Wikström J, Lewén A, Enblad P. Cerebrovascular reserve in moyamoya disease: relation to cerebral blood flow, capillary dysfunction, oxygenation, and energy metabolism. Front Neurol 2023; 14:1190309. [PMID: 37545732 PMCID: PMC10397391 DOI: 10.3389/fneur.2023.1190309] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2023] [Accepted: 07/04/2023] [Indexed: 08/08/2023] Open
Abstract
Background Cerebral hemodynamics in moyamoya disease (MMD) is complex and needs further elucidation. The primary aim of the study was to determine the association of the cerebrovascular reserve (CVR) with cerebral blood flow (CBF) disturbances, oxygen extraction fraction (OEFmax), and energy metabolism (CMRO 2 max ) in MMD, using arterial spin label magnetic resonance imaging (ASL-MRI) before and after acetazolamide administration. Methods Thirty-nine ASL-MRI scans with a concurrent acetazolamide challenge from 16 MMD patients at the Uppsala University Hospital, Sweden, 2016-2021, were retrospectively analyzed. CBF was assessed before and 5, 15, and 25 min after acetazolamide administration, and the maximal response CVRmax was used for further analyses. Dynamic susceptibility contrast (DSC) MRI was performed 30 min after acetazolamide injection, and the data were analyzed using the Cercare Medical Neurosuite to assess capillary transit time heterogeneity (CTTH; indicating microvascular function), OEFmax, and CMRO 2 max . Results In the ACA territory, a lower CVRmax was associated with lower baseline CBF, higher CTTH, and higher OEFmax but not with CMRO 2 max in generalized estimating equation models. In the MCA territory, lower CVRmax was associated with lower baseline CBF and higher CMRO 2 max but not with CTTH and OEFmax.. Conclusion Altogether, a compromised CVR in MMD patients reflected disturbances in macro-/microvascular blood flow, oxygenation, and CMRO2. ASL-MRI with acetazolamide challenge is a feasible and radiation-free alternative to positron emission tomography (PET) imaging in MMD.
Collapse
Affiliation(s)
| | - Markus Fahlström
- Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Johan Wikström
- Department of Surgical Sciences, Section of Neuroradiology, Uppsala University, Uppsala, Sweden
| | - Anders Lewén
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| | - Per Enblad
- Department of Medical Sciences, Section of Neurosurgery, Uppsala University, Uppsala, Sweden
| |
Collapse
|
18
|
An S, Hwang G, Noh SA, Lee HC, Hwang TS. Quantitative Analysis of Brain CT Perfusion in Healthy Beagle Dogs: A Pilot Study. Vet Sci 2023; 10:469. [PMID: 37505873 PMCID: PMC10385523 DOI: 10.3390/vetsci10070469] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2023] [Revised: 07/11/2023] [Accepted: 07/16/2023] [Indexed: 07/29/2023] Open
Abstract
Brain computed tomography (CT) perfusion is a technique that allows for the fast evaluation of cerebral hemodynamics. However, quantitative studies of brain CT perfusion in veterinary medicine are lacking. The purpose of this study was to investigate the normal range of perfusion determined via CT in brains of healthy dogs and to compare values between white matter and gray matter, differences in aging, and each hemisphere. Nine intact male beagle dogs were prospectively examined using dynamic CT scanning and post-processing for brain perfusion. Regional cerebral blood volume (rCBV), regional cerebral blood flow (rCBF), mean transit time, and time to peak were calculated. Tissue ROIs were drawn in the gray matter and white matter of the frontal, temporal, parietal, and occipital lobes; caudate nucleus; thalamus; piriform lobe; hippocampus; and cerebellum. Significant differences were observed between the white matter regions and gray matter regions for rCBV and rCBF (p < 0.05). However, no significant differences were identified between hemispheres and between young and old groups in brain regions. The findings obtained in this study involving healthy beagle dogs might serve as a reference for regional CT perfusion values in specific brain regions. These results may aid in the characterization of various brain diseases in dogs.
Collapse
Affiliation(s)
- Soyon An
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Gunha Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Seul Ah Noh
- AniCom Medical Center, Animal Hospital, Seoul 04599, Republic of Korea
| | - Hee Chun Lee
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| | - Tae Sung Hwang
- Institute of Animal Medicine, College of Veterinary Medicine, Gyeongsang National University, Jinju 52828, Republic of Korea
| |
Collapse
|
19
|
Arikan F, Chocron I, Calvo-Rubio H, Santos C, Gándara D. Metabolism changes during direct revascularization in moyamoya disease: illustrative case. J Neurosurg Case Lessons 2023; 5:CASE23104. [PMID: 37399148 PMCID: PMC10550542 DOI: 10.3171/case23104] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/27/2023] [Accepted: 04/14/2023] [Indexed: 07/05/2023]
Abstract
BACKGROUND Cerebral revascularization is recommended for patients with moyamoya disease (MMD) with reduced cerebral perfusion reserve and recurrent or progressive ischemic events. The standard surgical treatment for these patients is a low-flow bypass with or without indirect revascularization. The use of intraoperative monitoring of the metabolic profile using analytes such as glucose, lactate, pyruvate, and glycerol has not yet been described during cerebral artery bypass surgery for MMD-induced chronic cerebral ischemia. The authors aimed to describe an illustrative case using intraoperative microdialysis and brain tissue oxygen partial pressure (PbtO2) probes in a patient with MMD during direct revascularization. OBSERVATIONS The patient's severe tissue hypoxia situation was confirmed by a PbtO2:partial pressure of oxygen (PaO2) ratio below 0.1 and anaerobic metabolism by a lactate:pyruvate ratio greater than 40. Following bypass, a rapid and sustained increase in PbtO2 up to normal values (PbtO2:PaO2 ratio between 0.1 and 0.35) and the normalization of cerebral energetic metabolism with a lactate/pyruvate ratio less than 20 was observed. LESSONS The results show a quick improvement of regional cerebral hemodynamics due to the direct anastomosis procedure, reducing the incidence of subsequent ischemic stroke in pediatric and adult patients immediately.
Collapse
Affiliation(s)
- Fuat Arikan
- Department of Neurosurgery and
- Neurotraumatology Neurosurgery Research Unit (UNINN), Vall d‘Hebron Research Institute (VHIR), Barcelona, Spain; and
| | - Ivette Chocron
- Department of Anesthesiology, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | | | - Dario Gándara
- Department of Neurosurgery and
- Neurotraumatology Neurosurgery Research Unit (UNINN), Vall d‘Hebron Research Institute (VHIR), Barcelona, Spain; and
| |
Collapse
|
20
|
Zhou Z, Jiedan MU, Liangxiao MA, Wenyan YU, Tianyi S, Xu Q, Yuan T, Yidan Z, Junxiang W. Waggle needling Yanglingquan (GB34) enhances cerebral blood flow and ameliorates condition of spastic paresis in rats with middle cerebral artery occlusion induced by surgical nylon suture. J TRADIT CHIN MED 2023; 43:514-522. [PMID: 37147753 PMCID: PMC10133960 DOI: 10.19852/j.cnki.jtcm.20230328.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
OBJECTIVE To evaluate the therapeutic efficacy and the influence on cerebral blood supply of waggle needling Yanglingquan (GB34) on spastic paresis (SP) rats after middle cerebral artery occlusion (MCAO) induced and investigate its mechanism of relieving neurobehavior deficiency. METHODS SP rat model was produced by permanent MCAO. Rats were divided into five groups: blank control group (Control), sham operation group (Sham), model group (Model), waggle needling group (WN) and perpendicular needling group (PN). SP rats were treated with acupuncture from day 3 after MCAO, once a day for 6 d. The modified neurological severity score (mNSS) and modified Ashworth scale (MAS) were conducted on days 0, 1, 3, 5, 7 and 9. Cerebral blood flow (CBF) in ischemic cortex was measured by laser speckle imaging 5 min pre ischemia, 5 min post ischemia, and after intervention on day 9. All rats were sacrificed at day 9 and the protein and mRNA expressions of γ2 subunit of the γ-aminobutyric acid receptor A (GABAAγ2) and K+-Cl?cotransporter 2 (KCC2) in the ischemic cortex and lumber enlargement was measured by Western blotting and real-time quantitative polymerase chain reaction. RESULTS Both Control and Sham groups showed no changes in mNSS and MAS scores and in the regional CBF. Compared with Model group, both WN and PN treatments significantly ameliorated neurological deficit ( 0.01), decreased muscle tone ( 0.05), and enhanced CBF ( 0.001) in SP rats; moreover, WN showed superior effects than PN ( 0.001). In line with the improvement in neurobehavior, acupuncture interventions up-regulated the expressions of GABAAγ2 and KCC2 in the ischemic cortex as well as lumber enlargement ( 0.01) in SP rats, and those changes were more obvious in WN ( 0.05). CONCLUSIONS Acupuncture at Yanglingquan (GB34) enhanced cerebral blood flow and ameliorated SP in permanent MCAO rats, while waggle needling was superior to regular perpendicular needling. Waggle needling Yanglingquan (GB34) would be a potential complementary therapy for SP.
Collapse
Affiliation(s)
- Zhang Zhou
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - M U Jiedan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - M A Liangxiao
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
- 2 the Key Unit of State Administration of Traditional Chines Medicine, Evaluation of Characteristic Acupuncture Therapy, Beijing 100029, China
| | - Y U Wenyan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Sun Tianyi
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Qian Xu
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Tian Yuan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Zhang Yidan
- School of Acupuncture-Moxibustion and Tuina, Beijing University of Chinese Medicine, Beijing 100029, China
| | - Wang Junxiang
- School of Nursing, Beijing University of Chinese Medicine, Beijing 100029, China
| |
Collapse
|
21
|
Iadecola C, Smith EE, Anrather J, Gu C, Mishra A, Misra S, Perez-Pinzon MA, Shih AY, Sorond FA, van Veluw SJ, Wellington CL. The Neurovasculome: Key Roles in Brain Health and Cognitive Impairment: A Scientific Statement From the American Heart Association/American Stroke Association. Stroke 2023; 54:e251-e271. [PMID: 37009740 PMCID: PMC10228567 DOI: 10.1161/str.0000000000000431] [Citation(s) in RCA: 28] [Impact Index Per Article: 28.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/04/2023]
Abstract
BACKGROUND Preservation of brain health has emerged as a leading public health priority for the aging world population. Advances in neurovascular biology have revealed an intricate relationship among brain cells, meninges, and the hematic and lymphatic vasculature (the neurovasculome) that is highly relevant to the maintenance of cognitive function. In this scientific statement, a multidisciplinary team of experts examines these advances, assesses their relevance to brain health and disease, identifies knowledge gaps, and provides future directions. METHODS Authors with relevant expertise were selected in accordance with the American Heart Association conflict-of-interest management policy. They were assigned topics pertaining to their areas of expertise, reviewed the literature, and summarized the available data. RESULTS The neurovasculome, composed of extracranial, intracranial, and meningeal vessels, as well as lymphatics and associated cells, subserves critical homeostatic functions vital for brain health. These include delivering O2 and nutrients through blood flow and regulating immune trafficking, as well as clearing pathogenic proteins through perivascular spaces and dural lymphatics. Single-cell omics technologies have unveiled an unprecedented molecular heterogeneity in the cellular components of the neurovasculome and have identified novel reciprocal interactions with brain cells. The evidence suggests a previously unappreciated diversity of the pathogenic mechanisms by which disruption of the neurovasculome contributes to cognitive dysfunction in neurovascular and neurodegenerative diseases, providing new opportunities for the prevention, recognition, and treatment of these conditions. CONCLUSIONS These advances shed new light on the symbiotic relationship between the brain and its vessels and promise to provide new diagnostic and therapeutic approaches for brain disorders associated with cognitive dysfunction.
Collapse
|
22
|
Hadad S, Rangwala SD, Stout JN, Mut F, Orbach DB, Cebral JR, See AP. Understanding development of jugular bulb stenosis in vein of galen malformations: identifying metrics of complex flow dynamics in the cerebral venous vasculature of infants. Front Physiol 2023; 14:1113034. [PMID: 37275225 PMCID: PMC10236198 DOI: 10.3389/fphys.2023.1113034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 04/24/2023] [Indexed: 06/07/2023] Open
Abstract
Introduction: Computational fluid dynamics (CFD) assess biological systems based on specific boundary conditions. We propose modeling more advanced hemodynamic metrics, such as core line length (CL) and critical points which characterize complexity of flow in the context of cerebral vasculature, and specifically cerebral veins during the physiologically evolving early neonatal state of vein of Galen malformations (VOGM). CFD has not been applied to the study of arteriovenous shunting in Vein of Galen Malformations but could help illustrate the pathophysiology of this malformation. Methods: Three neonatal patients with VOGM at Boston Children's Hospital met inclusion criteria for this study. Structural MRI data was segmented to generate a mesh of the VOGM and venous outflow. Boundary condition flow velocity was derived from PC-MR sequences with arterial and venous dual velocity encoding. The mesh and boundary conditions were applied to model the cerebral venous flow. We computed flow variables including mean wall shear stress (WSSmean), mean OSI, CL, and the mean number of critical points (nCrPointsmean) for each patient specific model. A critical point is defined as the location where the shear stress vector field is zero (stationary point) and can be used to describe complexity of flow. Results: The division of flow into the left and right venous outflow was comparable between PC-MR and CFD modeling. A high complexity recirculating flow pattern observed on PC-MR was also identified on CFD modeling. Regions of similar WSSmean and OSImean (<1.3 fold) in the left and right venous outflow channels of a single patient have several-fold magnitude difference in higher order hemodynamic metrics (> 3.3 fold CL, > 1.7 fold nCrPointsmean). Specifically, the side which developed JBS in each model had greater nCrPointsmean compared to the jugular bulb with no stenosis (VOGM1: 4.49 vs. 2.53, VOGM2: 1.94 vs. 0, VOGM3: 1 vs. 0). Biologically, these regions had subsequently divergent development, with increased complexity of flow associating with venous stenosis. Discussion: Advanced metrics of flow complexity identified in computational models may reflect observed flow phenomena not fully characterized by primary or secondary hemodynamic parameters. These advanced metrics may indicate physiological states that impact development of jugular bulb stenosis in VOGM.
Collapse
Affiliation(s)
- Sara Hadad
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Shivani D. Rangwala
- Cerebrovascular Surgery and Interventions Center, Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, United States
- Department of Neurosurgery, University of Southern California LAC+USC, Los Angeles, CA, United States
| | - Jeffrey N. Stout
- Division of Newborn Medicine, Boston Children’s Hospital, Boston, MA, United States
| | - Fernando Mut
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Darren B. Orbach
- Cerebrovascular Surgery and Interventions Center, Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, United States
- Neurointerventional Radiology, Boston Children’s Hospital, Boston, MA, United States
| | - Juan R. Cebral
- Department of Bioengineering, George Mason University, Fairfax, VA, United States
| | - Alfred P. See
- Cerebrovascular Surgery and Interventions Center, Department of Neurosurgery, Boston Children’s Hospital, Boston, MA, United States
- Neurointerventional Radiology, Boston Children’s Hospital, Boston, MA, United States
| |
Collapse
|
23
|
Phukan P, Saikia B, Sarma A, Baruah SD, Das GC, Gayan PS. Retrospective Study of Normal Variations in Vertebral Artery on Computed Tomography Angiography With Special Emphasis on Relevant Embryology. Cureus 2023; 15:e38063. [PMID: 37234137 PMCID: PMC10208390 DOI: 10.7759/cureus.38063] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/24/2023] [Indexed: 05/27/2023] Open
Abstract
Background The vertebral arteries (VA) nourish the posterior cerebral circulation. Planning neck and cervical interventions like drilling and instrumentation, which involves VA manipulation, require an in-depth acquaintance with the normal and variant patterns encountered in the origin and course of the VA. Embryological events involved in forming these variant patterns can be correlated to their prior disposition in the lower vertebrate's understanding which becomes crucial while planning cervical interventions. Study design This is a single-center, retrospective study. Materials and methods The study involved 70 patients of both sexes and was done from September 2021 to February 2022 in the Department of Radiodiagnosis and Imaging at North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Meghalaya, India. The CT angiographies were studied for variations of VA under V1 - from origin to entrance into the foramen transversarium (FT), V2 - part inside FT, V3 - from its exit from FT till it pierces the cranial dura mater, and V4 - intracranial part. Further, VA was observed for its origin, dominance, level of entry in FT, and any associated anomalies. Results The VA was found mostly to be codominant. There was an opposite directional relationship between the basilar artery curvature and the dominance of VA. The association of ischemic events with hypoplastic VA was more on the left side (66.67%). Left VA originated from the aorta in 4.3% of subjects. One case presented a dual origin of VA. The abnormal origin of the LVA from the aorta showed a higher rate of abnormal entry into FT which was also found to be statistically significant. Conclusion Our study identifies and documents the anatomical variations present in VA specific to the population of northeast India by CT angiography and thus provides a much-needed reference for the healthcare professionals working in the field of Head and Neck interventions by providing opportunities further to understand these patterns for better diagnostic and therapeutic outcomes.
Collapse
Affiliation(s)
- Pranjal Phukan
- Radiology, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Bishwajeet Saikia
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Amitav Sarma
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Sudipta D Baruah
- Anatomy, North Eastern Indira Gandhi Regional Institute of Health and Medical Science (NEIGRIHMS), Shillong, IND
| | - Gautam C Das
- Anatomy, Silchar Medical College and Hospital, Silchar, IND
| | - Partha S Gayan
- Ophthalmology, Nagaon Medical College and Hospital, Nagaon, IND
| |
Collapse
|
24
|
Thatikunta PB, Zhou LW, Lee S. Dural Arteriovenous Fistula Presenting With Decreased Arterial-Spin-Labeling on Magnetic Resonance Imaging. Stroke 2023; 54:e69-e70. [PMID: 36382600 DOI: 10.1161/strokeaha.122.040639] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Affiliation(s)
- Prateek B Thatikunta
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA (P.B.T., S.L.)
| | - Lily W Zhou
- Division of Neurology and Vancouver Stroke Program, University of British Columbia, Vancouver, Canada (L.W.Z.)
| | - Sarah Lee
- Department of Neurology and Neurological Sciences, Stanford University, Palo Alto, CA (P.B.T., S.L.)
| |
Collapse
|
25
|
Weijs RWJ, Shkredova DA, Brekelmans ACM, Thijssen DHJ, Claassen JAHR. Longitudinal changes in cerebral blood flow and their relation with cognitive decline in patients with dementia: Current knowledge and future directions. Alzheimers Dement 2023; 19:532-548. [PMID: 35485906 DOI: 10.1002/alz.12666] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/22/2021] [Revised: 02/24/2022] [Accepted: 02/28/2022] [Indexed: 01/15/2023]
Abstract
The pathophysiology underlying cognitive decline is multifactorial, with increasing literature suggesting a role for cerebrovascular health. Cerebral blood flow (CBF) is an important element of cerebrovascular health, which raises questions regarding the relation between CBF and cognitive decline. Cross-sectional studies demonstrate lower CBF in patients with cognitive decline compared to healthy age-matched peers. Remarkably, longitudinal studies do not support a link between CBF reductions and cognitive decline. These studies, however, are often limited by small sample sizes and may therefore be underpowered to detect small effect sizes. Therefore, through a systematic review and meta-analysis of longitudinal studies, we examined whether longitudinal changes in global CBF are related to cognitive decline in subjects with Alzheimer's disease, and qualitatively described findings on regional CBF. Considering the growing impact of dementia and the lack of treatment options, it is important to understand the role of CBF as a prognostic biomarker and/or treatment target in dementia.
Collapse
Affiliation(s)
- Ralf W J Weijs
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Daria A Shkredova
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Centre for Heart, Lung, and Vascular Health, School of Health and Exercise Sciences, University of British Columbia Okanagan, Kelowna, British Columbia, Canada
| | - Anna C M Brekelmans
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands
| | - Dick H J Thijssen
- Department of Physiology, Radboud Institute for Health Sciences, Radboud University Medical Center, Nijmegen, the Netherlands.,Research Institute for Sport and Exercise Science, Liverpool John Moores University, Liverpool, UK
| | - Jurgen A H R Claassen
- Department of Geriatrics, Radboud UMC Alzheimer's Center, Donders Institute for Brain, Cognition and Behaviour, Radboud University Medical Center, Nijmegen, the Netherlands
| |
Collapse
|
26
|
Morais A, Locascio JJ, Sansing LH, Lamb J, Nagarkatti K, Imai T, van Leyen K, Aronowski J, Koenig JI, Bosetti F, Lyden P, Ayata C. Embracing Heterogeneity in The Multicenter Stroke Preclinical Assessment Network (SPAN) Trial. Stroke 2023; 54:620-631. [PMID: 36601951 PMCID: PMC9870939 DOI: 10.1161/strokeaha.122.040638] [Citation(s) in RCA: 8] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
The Stroke Preclinical Assessment Network (SPAN) is a multicenter preclinical trial platform using rodent models of transient focal cerebral ischemia to address translational failure in experimental stroke. In addition to centralized randomization and blinding and large samples, SPAN aimed to introduce heterogeneity to simulate the heterogeneity embodied in clinical trials for robust conclusions. Here, we report the heterogeneity introduced by allowing the 6 SPAN laboratories to vary most of the biological and experimental model variables and the impact of this heterogeneity on middle cerebral artery occlusion (MCAo) performance. We included the modified intention-to-treat population of the control mouse cohort of the first SPAN trial (n=421) and examined the biological and procedural independent variables and their covariance. We then determined their impact on the dependent variables cerebral blood flow drop during MCAo, time to achieve MCAo, and total anesthesia duration using multivariable analyses. We found heterogeneity in biological and procedural independent variables introduced mainly by the site. Consequently, all dependent variables also showed heterogeneity among the sites. Multivariable analyses with the site as a random effect variable revealed filament choice as an independent predictor of cerebral blood flow drop after MCAo. Comorbidity, sex, use of laser Doppler flow to monitor cerebral blood flow, days after trial onset, and maintaining anesthesia throughout the MCAo emerged as independent predictors of time to MCAo. Total anesthesia duration was predicted by most independent variables. We present with high granularity the heterogeneity introduced by the biological and model selections by the testing sites in the first trial of cerebroprotection in rodent transient filament MCAo by SPAN. Rather than trying to homogenize all variables across all sites, we embraced the heterogeneity to better approximate clinical trials. Awareness of the heterogeneity, its sources, and how it impacts the study performance may further improve the study design and statistical modeling for future multicenter preclinical trials.
Collapse
Affiliation(s)
- Andreia Morais
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Joseph J. Locascio
- Department of Biostatistics, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | - Lauren H. Sansing
- Department of Neurology, Yale University School of Medicine, New Haven, CT USA
- Department of Immunobiology, Yale University School of Medicine, New Haven, CT USA
| | - Jessica Lamb
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Los Angeles, CA USA
| | - Karisma Nagarkatti
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Los Angeles, CA USA
| | - Takahiko Imai
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Klaus van Leyen
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
| | - Jaroslaw Aronowski
- Department of Neurology, McGovern Medical School, University of Texas HSC, Houston, TX, USA
| | - James I. Koenig
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA
| | - Francesca Bosetti
- National Institute of Neurological Disorders and Stroke, National Institutes of Health, Bethesda, MD USA
| | - Patrick Lyden
- Department of Physiology and Neuroscience, Zilkha Neurogenetic Institute, Los Angeles, CA USA
- Department of Neurology, Keck School of Medicine at USC, Los Angeles, CA USA
| | - Cenk Ayata
- Department of Radiology, Harvard Medical School, Massachusetts General Hospital, Charlestown, MA, USA
- Department of Neurology, Harvard Medical School, Massachusetts General Hospital, Boston, MA, USA
| | | |
Collapse
|
27
|
Winkelmeier L, Heit JJ, Adusumilli G, Geest V, Guenego A, Broocks G, Prüter J, Gloyer NO, Meyer L, Kniep H, Lansberg MG, Albers GW, Wintermark M, Fiehler J, Faizy TD. Poor venous outflow profiles increase the risk of reperfusion hemorrhage after endovascular treatment. J Cereb Blood Flow Metab 2023; 43:72-83. [PMID: 36127828 PMCID: PMC9875351 DOI: 10.1177/0271678x221127089] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To investigate whether unfavorable cerebral venous outflow (VO) predicts reperfusion hemorrhage after endovascular treatment (EVT), we conducted a retrospective multicenter cohort study of patients with acute ischemic stroke and large vessel occlusion (AIS-LVO). 629 AIS-LVO patients met inclusion criteria. VO profiles were assessed on admission CT angiography using the Cortical Vein Opacification Score (COVES). Unfavorable VO was defined as COVES ≤ 2. Reperfusion hemorrhages on follow-up imaging were subdivided into no hemorrhage (noRH), hemorrhagic infarction (HI) and parenchymal hematoma (PH). Patients with PH and HI less frequently achieved good clinical outcomes defined as 90-day modified Rankin Scale scores of ≤ 2 (PH: 13.6% vs. HI: 24.6% vs. noRH: 44.1%; p < 0.001). The occurrence of HI and PH on follow-up imaging was more likely in patients with unfavorable compared to patients with favorable VO (HI: 25.1% vs. 17.4%, p = 0.023; PH: 18.3% vs. 8.5%; p = <0.001). In multivariable regression analyses, unfavorable VO increased the likelihood of PH (aOR: 1.84; 95% CI: 1.03-3.37, p = 0.044) and HI (aOR: 2.05; 95% CI: 1.25-3.43, p = 0.005), independent of age, sex, admission National Institutes Health Stroke Scale scores and arterial collateral status. We conclude that unfavorable VO was associated with the occurrence of HI and PH, both related to worse clinical outcomes.
Collapse
Affiliation(s)
- Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gautam Adusumilli
- Department of Radiology, Stanford University School of Medicine, Stanford, CA, USA
| | - Vincent Geest
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Adrien Guenego
- Department of Interventional Neuroradiology, Erasme University Hospital, Brussels, Belgium
| | - Gabriel Broocks
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Julia Prüter
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Nils-Ole Gloyer
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Lukas Meyer
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Maarten G Lansberg
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Gregory W Albers
- Department of Neurology, Stanford University School of Medicine, Stanford, CA, USA
| | - Max Wintermark
- Department of Neuroradiology, MD Andersen Cancer Center, Houston, TX, USA
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| |
Collapse
|
28
|
Şahin H. Is there a correlation between dizziness and intracranial artery calcification? Rev Assoc Med Bras (1992) 2023; 69:426-429. [PMID: 36820772 PMCID: PMC10004277 DOI: 10.1590/1806-9282.20221098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/16/2022] [Accepted: 12/27/2022] [Indexed: 02/22/2023]
Abstract
OBJECTIVE This study aimed to investigate the correlation between dizziness and intracranial artery calcification. METHODS A total of 107 consecutive patients were recruited for this study. These patients were categorized into first (case) and second (control) groups. The first and second groups had complaints of dizziness and headache, respectively. All the patients had noncontrast cranial computed tomography images. Bilateral internal carotid arteries, bilateral vertebral arteries, and basilar arteries were evaluated for detecting burden of intracranial artery calcification. Finally, demographic characteristics, stroke risk factors, and burden of intracranial artery calcification of these two groups were compared. The Mann-Whitney U test, chi-square test, and Spearman's correlation were performed to analyze the study. RESULTS It was found that the first and second groups included 39 and 68 patients, respectively. The mean age of the first group was significantly higher than that of the second group. The mean burden of intracranial artery calcification of the posterior circulation in the first and second groups were not statistically different from each other (p=0.555). The mean burden of intracranial artery calcification of the anterior circulation in the first group was found to be significantly higher than the second group (p=0.005). However, no significant difference was found between the two groups in terms of burden of intracranial artery calcification of anterior or posterior circulation, when the age variable was synchronized in both groups. CONCLUSION Although this study found a limited correlation between dizziness and intracranial artery calcification, this situation was basically related to aging.
Collapse
Affiliation(s)
- Hamza Şahin
- Kahramanmaraş Sütçü İmam Üniversitesi, Medical Faculty, Department of Neurology - Kahramanmaraş, Turkey
| |
Collapse
|
29
|
Inuo C, Soneda A. Reduced cerebral blood flow in an infant with severe atopic dermatitis. Pediatr Int 2023; 65:e15563. [PMID: 37368505 DOI: 10.1111/ped.15563] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/20/2022] [Revised: 04/23/2023] [Accepted: 05/02/2023] [Indexed: 06/29/2023]
Affiliation(s)
- Chisato Inuo
- Department of Allergy, Kanagawa Children's Medical Center, Yokohama, Japan
| | - Akiko Soneda
- Department of Allergy, Kanagawa Children's Medical Center, Yokohama, Japan
| |
Collapse
|
30
|
Winkelmeier L, Heit JJ, Adusumilli G, Geest V, Christensen S, Kniep H, van Horn N, Steffen P, Bechstein M, Sporns P, Lansberg MG, Albers GW, Wintermark M, Fiehler J, Faizy TD. Hypoperfusion Intensity Ratio Is Correlated With the Risk of Parenchymal Hematoma After Endovascular Stroke Treatment. Stroke 2023; 54:135-143. [PMID: 36416127 DOI: 10.1161/strokeaha.122.040540] [Citation(s) in RCA: 7] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Parenchymal hematoma (PH) is a major complication after endovascular treatment (EVT) for ischemic stroke. The hypoperfusion intensity ratio (HIR) represents a perfusion parameter reflecting arterial collateralization and cerebral microperfusion in ischemic brain tissue. We hypothesized that HIR correlates with the risk of PH after EVT. METHODS Retrospective multicenter cohort study of patients with large vessel occlusion who underwent EVT between 2013 and 2021 at one of the 2 comprehensive stroke centers (University Medical Center Hamburg-Eppendorf, Germany and Stanford University School of Medicine, CA). HIR was automatically calculated on computed tomography perfusion studies as the ratio of brain volume with time-to-max (Tmax) delay >10 s over volume with Tmax >6 s. Reperfusion hemorrhages were assessed according to the Heidelberg Bleeding Classification. Primary outcome was PH occurrence (PH+) or absence (PH-) on follow-up imaging. Secondary outcome was good clinical outcome defined as a 90-day modified Rankin Scale score of 0 to 2. RESULTS A total of 624 patients met the inclusion criteria. We observed PH in 91 (14.6%) patients after EVT. PH+ patients had higher HIR on admission compared with PH- patients (median, 0.6 versus 0.4; P<0.001). In multivariable regression, higher admission blood glucose (adjusted odds ratio [aOR], 1.08 [95% CI, 1.04-1.13]; P<0.001), extensive baseline infarct defined as Alberta Stroke Program Early CT Score ≤5 (aOR, 2.48 [1.37-4.42]; P=0.002), and higher HIR (aOR, 1.22 [1.09-1.38]; P<0.001) were independent determinants of PH after EVT. Both higher HIR (aOR, 0.83 [0.75-0.92]; P<0.001) and PH on follow-up imaging (aOR, 0.39 [0.18-0.80]; P=0.013) were independently associated with lower odds of achieving good clinical outcome. CONCLUSIONS Poorer (higher) HIR on admission perfusion imaging was strongly associated with PH occurrence after EVT. HIR as a surrogate for cerebral microperfusion might reflect tissue vulnerability for reperfusion hemorrhages. This automated and quickly available perfusion parameter might help to assess the need for intensive medical care after EVT.
Collapse
Affiliation(s)
- Laurens Winkelmeier
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Jeremy J Heit
- Department of Radiology, Stanford University School of Medicine, CA (J.J.H., G.A.)
| | - Gautam Adusumilli
- Department of Radiology, Stanford University School of Medicine, CA (J.J.H., G.A.)
| | - Vincent Geest
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Soren Christensen
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (S.C., M.G.L., G.W.A.)
| | - Helge Kniep
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Noel van Horn
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Paul Steffen
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Matthias Bechstein
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Peter Sporns
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.).,Department of Diagnostic and Interventional Neuroradiology, University Hospital Basel, Switzerland (P.S.)
| | - Maarten G Lansberg
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (S.C., M.G.L., G.W.A.)
| | - Gregory W Albers
- Department of Neurology and Neurological Sciences, Stanford University School of Medicine, CA (S.C., M.G.L., G.W.A.)
| | - Max Wintermark
- Department of Neuroradiology, MD Anderson, Houston, TX (M.W.)
| | - Jens Fiehler
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| | - Tobias D Faizy
- Department of Neuroradiology, University Medical Center Hamburg-Eppendorf, Germany (L.W., V.G., H.K., N.v.H., P.S., M.B., P.S., J.F., T.D.F.)
| |
Collapse
|
31
|
Santos DPDAD, Thirumala PD, Reddy G, Barros DFD, Faria VNR, Shandal V, Kurtz P. Risk of perioperative stroke and cerebral autoregulation monitoring: a systematic review. Arq Neuropsiquiatr 2022; 80:1196-1203. [PMID: 36580956 PMCID: PMC9800166 DOI: 10.1055/s-0042-1758648] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
BACKGROUND Perioperative stroke, delirium, and cognitive impairment could be related to management and to variations in blood pressure control, cerebral hypoperfusion and raised blood volume. Cerebral autoregulation (CAR) is a mechanism to maintain cerebral perfusion through the control of the vascular tone and hemodynamic reactions in the circulation. OBJECTIVE The present systematic review addresses the relationship between impaired CAR and perioperative stroke by evaluating the rate of neurological complications after surgery in studies in which perioperative CAR was tested or monitored. METHODS We included randomized clinical trials and prospective observational studies. All studies had adjusted the relative risk, hazard ratio or 95% confidence interval (95%CI) values. These estimation effects were tested using random-effects models. Heterogeneity among the selected studies was assessed using the Higgins and Thompson I2 statistics. RESULTS The Web of Science, PubMed and EMBASE electronic databases were searched to retrieve articles. A total of 4,476 studies published between 1983 and 2019 were analyzed, but only 5 qualified for the data extraction and were included in the final analysis. The combined study cohort comprised 941 patients who underwent CAR monitoring during surgical procedures. All studies provided information about perioperative stroke, which equated to 16% (158 of 941) of the overall patient population. CONCLUSION The present meta-analysis showed evidence of the impact of CAR impairment in the risk of perioperative stroke. On the pooled analysis, blood fluctuations or other brain insults large enough to compromise CAR were associated with the outcome of stroke (odds ratio [OR]: 2.26; 95%CI: 1.54-2.98; p < 0.0001).
Collapse
Affiliation(s)
- Daniel Paes de Almeida dos Santos
- Hospital Copa Star, Centro de Terapia Intensiva, Rio de Janeiro RJ, Brazil.,Sinapse Clínica, Rio de Janeiro RJ, Brazil.,Address for correspondence Daniel P. A. Santos
| | | | - Gautama Reddy
- Sinapse Clínica, Rio de Janeiro RJ, Brazil.,Intraneuro, Rio de Janeiro RJ, Brazil.
| | | | - Vinicius Naves Rezende Faria
- Sinapse Clínica, Rio de Janeiro RJ, Brazil.,Universidade Federal de Uberlândia, Faculdade de Engenharia Elétrica, Uberlândia MG, Brazil.
| | - Varun Shandal
- University of Pittsburgh Medical Center, Pittsburgh, Pennsylvania, United States.
| | - Pedro Kurtz
- Instituto D'Or de Pesquisa e Ensino, Departamento de Cuidado Intensivo, São Paulo SP, Brazil.
| |
Collapse
|
32
|
Irisawa H, Inui N, Mizushima T, Watanabe H. Cerebral Blood Deoxygenation by a Postural Change Detected by Near-Infrared Spectroscopy Has a Close Association with Cerebral Infarction. Brain Sci 2022; 12:1419. [PMID: 36291352 PMCID: PMC9599262 DOI: 10.3390/brainsci12101419] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/05/2022] [Revised: 10/18/2022] [Accepted: 10/19/2022] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND The recent introduction of near-infrared spectroscopy has enabled the monitoring of cerebral blood flow in real-time. Previous studies have shown that blood flow velocity is a predictor of cardiovascular disease. We hypothesized that cerebral oxygenation with a change in posture is a predictor for cerebral infarction. We designed a cross-sectional study to investigate the relationship between postural-related changes in cerebral oxygenation and a history of chronic cerebral infarction. METHODS A total of 100 consecutive participants were enrolled in this study. We evaluated changes in cerebral oxygenation with a change in posture from the supine to the upright position in the bilateral forehead. The association between a decline in cerebral oxygenation and chronic cerebral infarction was analyzed with multiple logistic regression adjusted for covariates. RESULTS Cerebral blood oxygenation increased in 52 participants and decreased in 48 participants with a postural change. The prevalence of decreased cerebral oxygenation was 76.3% in participants with chronic cerebral infarction. Multiple logistic regression analysis showed that a decline in cerebral oxygenation upon a postural change was strongly associated with chronic cerebral infarction (adjusted odds ratio: 3.42, p = 0.025). CONCLUSIONS Cerebral blood oxygenation upon a postural change could be a useful predictor for cerebral infarction.
Collapse
Affiliation(s)
- Hiroshi Irisawa
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
- Department of Rehabilitation Medicine, Dokkyo Medical University, Shimotsugagun 321-0293, Japan
- Department of Rehabilitation Medicine, Enshu Hospital, Hamamatsu 430-0929, Japan
| | - Naoki Inui
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| | - Takashi Mizushima
- Department of Rehabilitation Medicine, Dokkyo Medical University, Shimotsugagun 321-0293, Japan
| | - Hiroshi Watanabe
- Department of Clinical Pharmacology and Therapeutics, Hamamatsu University School of Medicine, Hamamatsu 431-3192, Japan
| |
Collapse
|
33
|
Olesen ND, Egesborg AH, Frederiksen HJ, Kitchen CC, Svendsen LB, Olsen NV, Secher NH. Influence of blood pressure on internal carotid artery blood flow during combined propofol-remifentanil and thoracic epidural anesthesia. J Anaesthesiol Clin Pharmacol 2022; 38:580-587. [PMID: 36778814 PMCID: PMC9912875 DOI: 10.4103/joacp.joacp_575_20] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/29/2020] [Revised: 04/14/2021] [Accepted: 05/14/2021] [Indexed: 12/31/2022] Open
Abstract
Background and Aims Anesthesia often reduces mean arterial pressure (MAP) to a level that may compromise cerebral blood flow. We evaluated whether phenylephrine treatment of anesthesia-induced hypotension affects internal carotid artery (ICA) blood flow and whether anesthesia affects ICA flow and CO2 reactivity. Material and Methods The study included twenty-seven patients (65 ± 11 years; mean ± SD) undergoing esophageal resection (n = 14), stomach resection (n = 12), or a gastroentero anastomosis (n = 1) during combined propofol-remifentanil and thoracic epidural anesthesia. Duplex ultrasound evaluated ICA blood flow. Evaluations were before and after induction of anesthesia, before and after the administration of phenylephrine as part of standard care to treat anesthesia-induced hypotension at a MAP below 60 mmHg, and the hypocapnic reactivity of ICA flow was determined before and during anesthesia. Results Induction of anesthesia reduced MAP from 108 ± 12 to 66 ± 16 mmHg (P < 0.0001) and ICA flow from 340 ± 92 to 196 ± 52 mL/min (P < 0.0001). Phenylephrine was administered to 24 patients (0.1-0.2 mg) and elevated MAP from 53 ± 8 to 73 ± 8 mmHg (P = 0.0001) and ICA flow from 191 ± 43 to 218 ± 50 mL/min (P = 0.0276). Furthermore, anesthesia reduced the hypocapnic reactivity of ICA flow from 23 (18-33) to 14%/kPa (10-22; P = 0.0068). Conclusion Combined propofol-remifentanil and thoracic epidural anesthesia affect ICA flow and CO2 reactivity. Phenylephrine partly restored ICA flow indicating that anesthesia-induced hypotension contributes to the reduction in ICA flow.
Collapse
Affiliation(s)
- Niels D. Olesen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200, Copenhagen N, Denmark
| | - Astrid H. Egesborg
- Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Hans-Jørgen Frederiksen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Carl-Christian Kitchen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Lars B. Svendsen
- Department of Surgical Gastroenterology, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| | - Niels V. Olsen
- Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
- Department of Biomedical Sciences, University of Copenhagen, Blegdamsvej 3, DK-2200, Copenhagen N, Denmark
| | - Niels H. Secher
- Department of Anesthesia, Rigshospitalet, University of Copenhagen, Copenhagen, Blegdamsvej 9, DK-2100 Copenhagen Ø, Denmark
| |
Collapse
|
34
|
Yuan S, Huang X, Ma W, Yang R, Xu F, Han D, Huang T, Peng MI, Xu A, Lyu J. Associations of HDL-C/LDL-C with myocardial infarction, all-cause mortality, haemorrhagic stroke and ischaemic stroke: a longitudinal study based on 384 093 participants from the UK Biobank. Stroke Vasc Neurol 2022; 8:119-126. [PMID: 36150733 PMCID: PMC10176979 DOI: 10.1136/svn-2022-001668] [Citation(s) in RCA: 16] [Impact Index Per Article: 8.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2022] [Accepted: 09/13/2022] [Indexed: 11/04/2022] Open
Abstract
OBJECTIVE To explore the correlations of high-density lipoprotein cholesterol (HDL-C)/low-density lipoprotein cholesterol (LDL-C) with myocardial infarction (MI), all-cause mortality, haemorrhagic stroke and ischaemic stroke, as well as the joint association of genetic susceptibility and HDL-C/LDL-C with the MI risk. METHODS AND RESULTS This study selected 384 093 participants from the UK Biobank (UKB) database. First, restricted cubic splines indicated non-linear associations of HDL-C/LDL-C with MI, ischaemic stroke and all-cause mortality. Second, a Cox proportional-hazards model indicated that compared with HDL-C/LDL-C=0.4-0.6, HDL-C/LDL-C<0.4 and >0.6 were correlated with all-cause mortality (HR=0.97 for HDL-C/LDL-C<0.4, 95% CI=0.939 to 0.999, p<0.05; HR=1.21 for HDL-C/LDL-C>0.6, 95% CI=1.16 to 1.26, p<0.001) after full multivariable adjustment. HDL-C/LDL-C<0.4 was correlated with a higher MI risk (HR=1.36, 95% CI=1.28 to 1.44, p<0.05) and ischaemic stroke (HR=1.12, 95% CI=1.02 to 1.22, p<0.05) after full multivariable adjustment. HDL-C/LDL-C>0.6 was associated with higher risk haemorrhagic stroke risk after full multivariable adjustment (HR=1.25, 95% CI=1.03 to 1.52, p<0.05). Third, after calculating the coronary heart disease Genetic Risk Score (CHD-GRS) of each participant, the Cox proportional-hazards model indicated that compared with low CHD-GRS and HDL-C/LDL-C=0.4-0.6, participants with a combination of high CHD-GRS and HDL-C/LDL-C<0.4 were associated with the highest MI risk (HR=2.45, 95% CI=2.15 to 2.8, p<0.001). Participants with HDL-C/LDL-C<0.4 were correlated with a higher MI risk regardless of whether they had a high, intermediate or low CHD-GRS. CONCLUSION In UKB participants, HDL-C/LDL-C ratio of 0.4-0.6 was correlated with lower MI risk, all-cause mortality, haemorrhagic stroke and ischaemic stroke. Participants with HDL-C/LDL-C<0.4 were correlated with a higher MI risk regardless of whether they had a high, intermediate or low CHD-GRS. The clinical significance and impact of HDL-C/LDL-C need to be further verified in future studies.
Collapse
Affiliation(s)
- Shiqi Yuan
- Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Xiaxuan Huang
- Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Wen Ma
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Rui Yang
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Fengshuo Xu
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Didi Han
- School of Public Health, Xi'an Jiaotong University, Xi'an, Shaanxi, China
| | - Tao Huang
- Department of Clinical Research, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - MIn Peng
- Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Anding Xu
- Department of Neurology, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China
| | - Jun Lyu
- Department of Clinical Research, Jinan University First Affiliated Hospital, Guangzhou, Guangdong, China .,Guangdong Provincial Key Laboratory of Traditional Chinese Medicine Informatization, Guangzhou, Guangdong, China
| |
Collapse
|
35
|
Kawano H, Yamada S, Tsuji A, Tsuji K, Nozaki K. Four-Dimensional Flow Magnetic Resonance Imaging Analysis of Cerebral Aneurysm in the Carotid Rete Mirabile. Stroke 2022; 53:e519-e520. [PMID: 36128903 DOI: 10.1161/strokeaha.122.040692] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Hiroto Kawano
- Department of Neurosurgery, Shiga University of Medical Science, Japan (H.K., S.Y., A.T., K.N.)
| | - Shigeki Yamada
- Department of Neurosurgery, Shiga University of Medical Science, Japan (H.K., S.Y., A.T., K.N.)
| | - Atsushi Tsuji
- Department of Neurosurgery, Shiga University of Medical Science, Japan (H.K., S.Y., A.T., K.N.)
| | - Keiichi Tsuji
- Department of Neurosurgery, Kyoto City Hospital, Japan (K.T.)
| | - Kazuhiko Nozaki
- Department of Neurosurgery, Shiga University of Medical Science, Japan (H.K., S.Y., A.T., K.N.)
| |
Collapse
|
36
|
Robertson TJ, McCulloch TJ, Paleologos MS, Downey RG, Loadsman JA, Thanigasalam R, Leslie S. Effects of sevoflurane versus propofol on cerebral autoregulation during anaesthesia for robot-assisted laparoscopic prostatectomy. Anaesth Intensive Care 2022; 50:361-367. [PMID: 35574717 DOI: 10.1177/0310057x211061158] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022]
Abstract
Robot-assisted laparoscopic prostatectomy requires a pneumoperitoneum combined with steep Trendelenburg positioning, and these conditions can be associated with impairment of cerebral autoregulation. The objective of this study was to determine if choice of anaesthetic agent affects the preservation of cerebral autoregulation during robot-assisted laparoscopic prostatectomy. We randomly assigned 30 patients to maintenance of general anaesthesia with either propofol or sevoflurane. Cerebral autoregulation was tested by administration of intravenous phenylephrine to increase mean arterial pressure from approximately 80 mmHg to 100 mmHg while assessing cerebral blood flow using transcranial Doppler ultrasonography. Autoregulation was first tested in the supine position and then approximately once every hour after Trendelenburg positioning. The main outcome measure was the result of the final autoregulation test prior to completion of surgery. At that time, we found cerebral autoregulation to be significantly impaired in six of the 15 patients receiving sevoflurane and none of the 15 patients receiving propofol (P = 0.02). However, it should be noted that some patients in the propofol group had impaired autoregulation on earlier tests. In conclusion, we found that autoregulation during robot-assisted laparoscopic prostatectomy is less likely to be impaired with propofol compared to sevoflurane anaesthesia, particularly towards the end of the surgery.
Collapse
Affiliation(s)
| | - Timothy J McCulloch
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Michael S Paleologos
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Ryan G Downey
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - John A Loadsman
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Anaesthetics, Royal Prince Alfred Hospital, Camperdown, Australia
| | - Ruban Thanigasalam
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Urology, Chris O'Brien Lifehouse, Camperdown, Australia
| | - Scott Leslie
- Sydney Medical School, University of Sydney, Sydney, Australia.,Department of Urology, Chris O'Brien Lifehouse, Camperdown, Australia
| |
Collapse
|
37
|
van Rijssel AE, Stins BC, Beishon LC, Sanders ML, Quinn TJ, Claassen JA, de Heus RA. Effect of Antihypertensive Treatment on Cerebral Blood Flow in Older Adults: a Systematic Review and Meta-Analysis. Hypertension 2022; 79:1067-1078. [PMID: 35193363 PMCID: PMC8997667 DOI: 10.1161/hypertensionaha.121.18255] [Citation(s) in RCA: 19] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/15/2021] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
BACKGROUND In older age, the benefits of antihypertensive treatment (AHT) become less evident, with greater associated risk. Of particular concern is compromising cerebral blood flow (CBF), especially in those with cognitive impairment. METHODS We created a synthesis of the published evidence by searching multiple electronic databases from 1970 to May 2021. Included studies had participants with mean age ≥50 years, hypertension or cognitive impairment, and assessed CBF before and after initiating AHT. Two authors independently determined eligibility and extracted data. Study quality was assessed using The Risk of Bias in Nonrandomized Studies of Interventions tool. We summarized study characteristics (qualitative synthesis) and performed random-effects meta-analyses (quantitative synthesis). RESULTS Thirty-two studies (total n=1306) were included, of which 23 were eligible for meta-analysis. In line with the qualitative synthesis, the meta-analysis indicated no effect of AHT initiation on CBF (standardized mean difference, 0.08 [95% CI, -0.07 to 0.22]; P=0.31, I2=42%). This was consistent across subgroups of acute versus chronic AHT, drug class, study design, and CBF measurement. Subgroups by age demonstrated an increase in CBF after AHT in those aged >70 years (standardized mean difference, 4.15 [95% CI, 0.16-8.15]; P=0.04, I2=42%), but not in those aged 50 to 65 and 65 to 70 years (standardized mean difference, 0.18 [95% CI,-2.02 to 2.38]; P=0.87, I2=49%; standardized mean difference, 1.22 [95% CI, -0.45 to 2.88]; P=0.15, I2=68%). Overall, risk of bias was moderate-to-high and quality of evidence (Grading of Recommendations Assessment, Development and Evaluation) was very low, reflecting the observational nature of the data. CONCLUSIONS Accepting the observed limitations, current evidence does not suggest a harmful effect of AHT on CBF. Concerns over CBF should not preclude treatment of hypertension.
Collapse
Affiliation(s)
- Anniek E. van Rijssel
- Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands (A.E.v.R., B.C.S., M.L.S., J.A.H.R.C., R.A.A.d.H.)
| | - Bram C. Stins
- Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands (A.E.v.R., B.C.S., M.L.S., J.A.H.R.C., R.A.A.d.H.)
| | - Lucy C. Beishon
- Department of Cardiovascular Sciences, University of Leicester, United Kingdom (L.C.B.)
| | - Marit L. Sanders
- Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands (A.E.v.R., B.C.S., M.L.S., J.A.H.R.C., R.A.A.d.H.)
| | - Terence J. Quinn
- Institute of Cardiovascular and Medical Sciences, University of Glasgow, United Kingdom (T.J.Q.)
| | - Jurgen A.H.R. Claassen
- Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands (A.E.v.R., B.C.S., M.L.S., J.A.H.R.C., R.A.A.d.H.)
| | - Rianne A.A. de Heus
- Radboud university medical center, Donders Institute for Brain Cognition and Behaviour, Department of Geriatric Medicine, Radboudumc Alzheimer Center, Nijmegen, the Netherlands (A.E.v.R., B.C.S., M.L.S., J.A.H.R.C., R.A.A.d.H.)
| |
Collapse
|
38
|
Kishihara Y, Yasuda H, Kashiura M, Harada N, Moriya T. Can Cerebral Regional Oxygen Saturation (rSO 2) Be Used as an Indicator of the Quality of Chest Compressions in Patients With Cardiopulmonary Arrest? A Study Evaluating the Association Between rSO 2 and Mean Arterial Pressure: The PRESS Study. Front Med (Lausanne) 2022; 9:810449. [PMID: 35273974 PMCID: PMC8902151 DOI: 10.3389/fmed.2022.810449] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2021] [Accepted: 01/11/2022] [Indexed: 01/14/2023] Open
Abstract
Introduction Sudden cardiac arrest causes numerous deaths worldwide. High-quality chest compressions are important for good neurological recovery. Arterial pressure is considered useful to monitor the quality of chest compressions by the American Heart Association. However, arterial pressure catheter might be inconvenient during resuscitation. Conversely, cerebral regional oxygen saturation (rSO2) during resuscitation may be associated with a good neurological prognosis. Therefore, we aimed to evaluate the correlation between mean arterial pressure and rSO2 during resuscitation to evaluate rSO2 as an indicator of the quality of chest compressions. Materials and Methods This study was a single-center, prospective, observational study. Patients with out-of-hospital cardiac arrest who were transported to a tertiary care emergency center in Japan between October 2014 and March 2015 were included. The primary outcome was the regression coefficient between mean arterial pressure (MAP) and rSO2. MAP and rSO2 were measured during resuscitation (at hospital arrival [0 min], 3, 6, 9, 12, and 15 min), and MAP was measured by using an arterial catheter inserted into the femoral artery. For analysis, we used the higher value of rSO2 obtained from the left and right forehead of the patient measured using a near-infrared spectrometer. Regression coefficients were calculated using the generalized estimating equation with MAP and systolic arterial pressure as response variables and rSO2 as an explanatory variable since MAP and rSO2 were repeatedly measured in the same patient. Since the confounding factors between MAP or systolic arterial pressure and rSO2 were not clear clinically or from previous studies, the generalized estimating equation was analyzed using a univariate analysis. Results In this study, 37 patients were analyzed. The rSO2 and MAP during resuscitation from hospital arrival to 15 min later were expressed as follows: (median [interquartile range, IQR]): rSO2, 29.5 (24.3–38.8)%, and MAP, 36.5 (26–46) mmHg. The regression coefficient (95% CI) of log-rSO2 and log-MAP was 0.42 (0.03–0.81) (p = 0.035). Conclusion The values of rSO2 and MAP showed a mild but statistically significant association. rSO2 could be used to assess the quality of chest compressions during resuscitation as a non-invasive and simple method.
Collapse
Affiliation(s)
- Yuki Kishihara
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Hideto Yasuda
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan.,Department of Clinical Research Education and Training Unit, Keio University Hospital Clinical and Translational Research Center (CTR), Tokyo, Japan
| | - Masahiro Kashiura
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| | - Naoshige Harada
- Emergency and Critical Care Medicine, Japanese Red Cross Musashino Hospital, Tokyo, Japan
| | - Takashi Moriya
- Department of Emergency and Critical Care Medicine, Jichi Medical University Saitama Medical Center, Saitama, Japan
| |
Collapse
|
39
|
Abstract
Leptomeningeal anastomoses are small distal anastomotic vessels also known as pial collaterals in the brain. These vessels redirect blood flow during an occlusion and are important for stroke treatment and outcome. Pial collaterals have unique hemodynamic forces and experience significantly increased luminal flow and shear stress after the onset of ischemic stroke. However, there is limited knowledge of how pial collaterals respond to flow and shear stress, and whether this response is altered in chronic hypertension. Using an in vitro system, pial collaterals from normotensive and hypertensive rats (n=6-8/group) were isolated and luminal flow was induced with intravascular pressure maintained at 40 mm Hg. Collateral lumen diameter was measured following each flow rate in the absence or presence of pharmacological inhibitors and activators. Collaterals from male and female Wistar rats dilated similarly to increased flow (2 µL/minute: 58.4±18.7% versus 67.9±7.4%; P=0.275), and this response was prevented by inhibition of the transient receptor potential vanilloid type 4 channel, as well as inhibitors of nitric oxide and intermediate-conductance calcium-activated potassium channels, suggesting shear stress-induced activation of this pathway was involved. However, the vasodilation was significantly impaired in hypertensive rats (2 µL/minute: 17.7±7.7%), which was restored by inhibitors of reactive oxygen species and mimicked by angiotensin II. Thus, flow- and shear stress-induced vasodilation of pial collaterals appears to be an important stimulus for increasing collateral flow during large vessel occlusion. Impairment of this response during chronic hypertension may be related to poorly engaged pial collaterals during ischemic stroke in hypertensive subjects.
Collapse
Affiliation(s)
- Zhaojin Li
- Department of Neurological Sciences, University of Vermont Robert Larner College of Medicine, Burlington, VT
| | - Marilyn J. Cipolla
- Department of Neurological Sciences, University of Vermont Robert Larner College of Medicine, Burlington, VT.,Department of Obstetrics, Gynecology, and Reproductive Sciences, University of Vermont Robert Larner College of Medicine, Burlington, VT.,Department of Pharmacology, University of Vermont Robert Larner College of Medicine, Burlington, VT
| |
Collapse
|
40
|
Sacco RL, Seastrong R. Achievements and New Initiatives for Stroke in 2022. Stroke 2022; 53:304-306. [PMID: 35073190 DOI: 10.1161/strokeaha.121.038326] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Ralph L Sacco
- Departments of Neurology, Public Health Sciences, Miami Clinical Translational Science Institute, Evelyn McKnight Brain Institute, Miller School of Medicine, University of Miami, FL (R.L.S.)
| | - Rebecca Seastrong
- Stroke Editorial Office, Scientific Publishing, American Heart Association, Dallas, TX (R.S.)
| |
Collapse
|
41
|
Kawabata Y, Imazu SI, Matsumoto K, Toyoda K, Kawano M, Kubo Y, Kinoshita S, Nishizawa Y, Kanazawa T. rTMS Therapy Reduces Hypofrontality in Patients With Depression as Measured by fNIRS. Front Psychiatry 2022; 13:814611. [PMID: 35815029 PMCID: PMC9257165 DOI: 10.3389/fpsyt.2022.814611] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/14/2021] [Accepted: 05/26/2022] [Indexed: 11/15/2022] Open
Abstract
Multichannel functional near-infrared spectroscopy (fNIRS) is a tool used to capture changes in cerebral blood flow. A consistent result for depression is a decrease in blood flow in the frontal cortex leading to hypofrontality, which indicates multidomain functional impairment. Repetitive transcranial magnetic stimulation (rTMS) and elective convulsive therapy (ECT) are alternatives to antidepressant drugs for the treatment of depression but the underlying mechanism is yet to be elucidated. The aim of the current study was to evaluate cerebral blood flow using fNIRS following rTMS treatment in patients with depression. The cerebral blood flow of 15 patients with moderate depression after rTMS treatment was measured using fNIRS. While there was clear hypofrontality during pre-treatment (5 ± 2.5), a notable increase in oxygenated hemoglobin was observed after 30 sessions with rTMS (50 ± 15). This increased blood flow was observed in a wide range of channels in the frontal cortex; however, the centroid values were similar between the treatments. Increased blood flow leads to the activation of neuronal synapses, as noted with other neuromodulation treatments such as electroconvulsive therapy. This study describes the rTMS-induced modulation of blood oxygenation response over the prefrontal cortex in patients with depression, as captured by fNIRS. Future longitudinal studies are needed to assess cerebral blood flow dynamics during rTMS treatment for depression.
Collapse
Affiliation(s)
- Yasuo Kawabata
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shin-Ichi Imazu
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Koichi Matsumoto
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Katsunori Toyoda
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Makoto Kawano
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoichiro Kubo
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Shinya Kinoshita
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan
| | - Yoshitaka Nishizawa
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan.,Stanford University, Stanford, CA, United States
| | - Tetsufumi Kanazawa
- Department of Neuropsychiatry, Osaka Medical and Pharmaceutical University, Osaka, Japan.,The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Melbourne, VIC, Australia
| |
Collapse
|
42
|
Palmer JA, Kaufman CS, Vidoni ED, Honea RA, Burns JM, Billinger SA. Sex Differences in Resilience and Resistance to Brain Pathology and Dysfunction Moderated by Cerebrovascular Response to Exercise and Genetic Risk for Alzheimer's Disease. J Alzheimers Dis 2022; 90:535-542. [PMID: 36155505 PMCID: PMC9731318 DOI: 10.3233/jad-220359] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/03/2023]
Abstract
Sex as a biological variable appears to contribute to the multifactorial etiology of Alzheimer's disease. We tested sex-based interactions between cerebrovascular function and APOE4 genotype on resistance and resilience to brain pathology and cognitive executive dysfunction in cognitively-normal older adults. Female APOE4 carriers had higher amyloid-β deposition yet achieved similar cognitive performance to males and female noncarriers. Further, female APOE4 carriers with robust cerebrovascular responses to exercise possessed lower amyloid-β. These results suggest a unique cognitive resilience and identify cerebrovascular function as a key mechanism for resistance to age-related brain pathology in females with high genetic vulnerability to Alzheimer's disease.
Collapse
Affiliation(s)
- Jacqueline A. Palmer
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America,University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States of America
| | - Carolyn S. Kaufman
- Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA
| | - Eric D. Vidoni
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States of America
| | - Robyn A. Honea
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States of America
| | - Jeffrey M. Burns
- University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States of America
| | - Sandra A. Billinger
- Department of Neurology, School of Medicine, University of Kansas Medical Center, Kansas City, KS, United States of America,University of Kansas Alzheimer’s Disease Research Center, Fairway, KS, United States of America,Department of Molecular & Integrative Physiology, University of Kansas Medical Center, Kansas City, KS, USA,Correspondence: Sandra A. Billinger, PT, PhD, FAHA, , Twitter: @Sandy_REACHlab
| |
Collapse
|
43
|
Oberdier MT, Antaki JF, Kharlamov A, Jones SC. Closed cranial window rodent model for investigating hemodynamic response to elevated intracranial pressure. Animal Model Exp Med 2021; 4:391-397. [PMID: 34977490 PMCID: PMC8690993 DOI: 10.1002/ame2.12187] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2021] [Revised: 09/24/2021] [Accepted: 10/24/2021] [Indexed: 11/08/2022] Open
Abstract
Background Elevated intracranial pressure (ICP) occurs in several physiological and pathological conditions, yet long-term sequellae are not common, which implies that blood flow is preserved above ischemic thresholds. Methods This pilot study sought to confirm this hypothesis using a closed cranial window model in a rat in which ICP was elevated to 120 mmHg for 12 min, and superficial cortical perfusion was measured by laser Doppler flowmetry and laser speckle flowmetry. Results Following a transient increase, cortical blood flow decreased to between 25% and 75% of baseline. These levels correspond to disrupted metabolism and decreased protein synthesis but did not exceed thresholds for electrical signaling or membrane integrity. This may partially explain how some episodes of elevated ICP remain benign. Conclusion The closed cranial window model provides a platform for prospective study of physiologic responses to artificially elevated ICP during neurosurgery to promote hemostasis.
Collapse
Affiliation(s)
- Matt T. Oberdier
- Department of Biomedical EngineeringCarnegie Mellon UniversityPittsburghPennsylvaniaUSA
| | - James F. Antaki
- Department of Biomedical EngineeringCarnegie Mellon UniversityPittsburghPennsylvaniaUSA
| | - Alexander Kharlamov
- Department of AnesthesiologyAllegheny‐Singer Research InstitutePittsburghPennsylvaniaUSA
| | - Stephen C. Jones
- Department of AnesthesiologyAllegheny‐Singer Research InstitutePittsburghPennsylvaniaUSA
| |
Collapse
|
44
|
Kovács-Ábrahám Z, Aczél T, Jancsó G, Horváth-Szalai Z, Nagy L, Tóth I, Nagy B, Molnár T, Szabó P. Cerebral and Systemic Stress Parameters in Correlation with Jugulo-Arterial CO 2 Gap as a Marker of Cerebral Perfusion during Carotid Endarterectomy. J Clin Med 2021; 10:jcm10235479. [PMID: 34884182 PMCID: PMC8658406 DOI: 10.3390/jcm10235479] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2021] [Revised: 10/30/2021] [Accepted: 11/21/2021] [Indexed: 11/16/2022] Open
Abstract
Intraoperative stress is common to patients undergoing carotid endarterectomy (CEA); thus, impaired oxygen and metabolic balance may appear. In this study, we aimed to identify new markers of intraoperative cerebral ischemia, with predictive value on postoperative complications during CEA, performed in regional anesthesia. A total of 54 patients with significant carotid stenosis were recruited and submitted to CEA. Jugular and arterial blood samples were taken four times during operation, to measure the jugulo-arterial carbon dioxide partial pressure difference (P(j-a)CO2), and cortisol, S100B, L-arginine, and lactate levels. A positive correlation was found between preoperative cortisol levels and all S100B concentrations. In addition, they are positively correlated with P(j-a)CO2 values. Conversely, postoperative cortisol inversely correlates with P(j-a)CO2 and postoperative S100B values. A negative correlation was observed between maximum systolic and pulse pressures and P(j-a)CO2 after carotid clamp and before the release of clamp. Our data suggest that preoperative cortisol, S100B, L-arginine reflect patients' frailty, while these parameters postoperatively are influenced by intraoperative stress and injury. As a novelty, P(j-a)CO2 might be an emerging indicator of cerebral blood flow during CEA.
Collapse
Affiliation(s)
- Zoltán Kovács-Ábrahám
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Timea Aczél
- Department of Pharmacology and Pharmacotherapy, Medical School, University of Pécs, H-7624 Pécs, Hungary;
- Molecular Pharmacology Research Group & Centre for Neuroscience, János Szentágothai Research Centre, University of Pécs, H-7624 Pécs, Hungary
| | - Gábor Jancsó
- Department of Vascular Surgery, Medical School, University of Pécs, H-7624 Pécs, Hungary;
| | - Zoltán Horváth-Szalai
- Department of Laboratory Medicine, Medical School, University of Pécs, H-7624 Pécs, Hungary;
| | - Lajos Nagy
- Department of Applied Chemistry, Institute of Chemistry, Faculty of Science and Technology, University of Debrecen, H-4032 Debrecen, Hungary;
| | - Ildikó Tóth
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Bálint Nagy
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Tihamér Molnár
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
| | - Péter Szabó
- Department of Anesthesiology and Intensive Care, Medical School, University of Pécs, H-7624 Pécs, Hungary; (Z.K.-Á.); (I.T.); (B.N.); (T.M.)
- Correspondence:
| |
Collapse
|
45
|
Affiliation(s)
- A Tan
- St George's University Hospitals NHS Foundation Trust, London, UK
| | - D Roberts
- St George's University Hospitals NHS Foundation Trust, London, UK
| |
Collapse
|
46
|
Abstract
This review discusses the clinical applications of the frozen elephant trunk procedure for patients with acute aortic dissection. Sub-analysis of the multicenter Japanese Frozenix study, J-ORCHESTRA, are presented, and recent reports of frozen elephant trunk usage for acute aortic dissection are discussed.
Collapse
Affiliation(s)
- Yutaka Okita
- Takatsuki General Hospital, Kobe University, Japan
| |
Collapse
|
47
|
Bekiesińska-Figatowska M, Szkudlińska-Pawlak S, Kwaśniewicz P, Duczkowska A, Ring M, Iwanowska B, Sawicki M. Arterial spin labeling in neonatal magnetic resonance imaging - first experience and new observations. Pol J Radiol 2021; 86:e415-24. [PMID: 34429788 DOI: 10.5114/pjr.2021.108165] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/05/2020] [Accepted: 01/04/2021] [Indexed: 11/17/2022] Open
Abstract
Purpose Arterial spin labeling (ASL) is a noninvasive non-contrast technique of perfusion imaging that uses endogenous water from the blood as the perfusion tracer, with very scant data on its use in neonates. The authors present the added value of ASL in the examined babies in their own material and discuss it in the light of the existing literature. Material and methods During the first 10 months after the purchase of a new magnetic resonance imaging (MRI) scanner, 123 neonates were examined using it in an MR-compatible incubator, 117 of them had brain MRI, and in 104 ASL was incorporated in the routine protocol, which resulted in prolongation of the study time by approximately 4 minutes. 3D ASL sequence uses Pulsed Continuous Arterial Spin Labeling (PCASL; aka pseudo continuous) technique. Results The quality of the cerebral blood flow (CBF) maps was good in all cases but 2 because all the babies were sedated. Apart from the knowledge about normal perfusion patterns in the preterm and term neonatal brains, the use of ASL sequence provided important additional information in 11 cases (10.8%): increased CBF correlating with electroencephalographic seizure localization in otherwise normal MRI (n = 1), increased CBF in the cortex without clinical information about seizures and with posthaemorrhagic changes (n = 1), increased CBF in the brain stem and decreased in the upper parts of the brain (n = 2), probably reflecting the homeostatic mechanism which allows preferential perfusion of the vital structures of the brain stem, hypoperfusion (n = 1) or hypoperfusion with peripheral hyperperfusion (n = 1) in the area of stroke, hypoperfusion of the posterior areas of the brain in the presence of subarachnoid or epidural haemorrhage (n = 3), significantly increased CBF in the presumed nidus of arteriovenous malformation causing haemorrhage (n = 1), and lack of perfusion in the supratentorial compartment in a case of suspected brain death (n = 1). Conclusions Our short experience but relatively large volume of material encourages the use of ASL in routine neonatal MRI as a useful and non-time-consuming tool providing additional important clinical information in a significant percentage of cases.
Collapse
|
48
|
Cipolla MJ. Thomas Willis Lecture: Targeting Brain Arterioles for Acute Stroke Treatment. Stroke 2021; 52:2465-2477. [PMID: 34102855 DOI: 10.1161/strokeaha.121.034620] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
Collapse
Affiliation(s)
- Marilyn J Cipolla
- Department of Neurological Sciences, University of Vermont, Burlington
| |
Collapse
|
49
|
Carra G, Flechet M, Jacobs A, Verstraete S, Vlasselaers D, Desmet L, Van Cleemput H, Wouters P, Vanhorebeek I, Van den Berghe G, Güiza F, Meyfroidt G. Postoperative Cerebral Oxygen Saturation in Children After Congenital Cardiac Surgery and Long-Term Total Intelligence Quotient: A Prospective Observational Study. Crit Care Med 2021; 49:967-976. [PMID: 33591016 PMCID: PMC8132917 DOI: 10.1097/ccm.0000000000004852] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
OBJECTIVES During the early postoperative period, children with congenital heart disease can suffer from inadequate cerebral perfusion, with possible long-term neurocognitive consequences. Cerebral tissue oxygen saturation can be monitored noninvasively with near-infrared spectroscopy. In this prospective study, we hypothesized that reduced cerebral tissue oxygen saturation and increased intensity and duration of desaturation (defined as cerebral tissue oxygen saturation < 65%) during the early postoperative period, independently increase the probability of reduced total intelligence quotient, 2 years after admission to a PICU. DESIGN Single-center, prospective study, performed between 2012 and 2015. SETTING The PICU of the University Hospitals Leuven, Belgium. PATIENTS The study included pediatric patients after surgery for congenital heart disease admitted to the PICU. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Postoperative cerebral perfusion was characterized with the mean cerebral tissue oxygen saturation and dose of desaturation of the first 12 and 24 hours of cerebral tissue oxygen saturation monitoring. The independent association of postoperative mean cerebral tissue oxygen saturation and dose of desaturation with total intelligence quotient at 2-year follow-up was evaluated with a Bayesian linear regression model adjusted for known confounders. According to a noninformative prior, reduced mean cerebral tissue oxygen saturation during the first 12 hours of monitoring results in a loss of intelligence quotient points at 2 years, with a 90% probability (posterior β estimates [80% credible interval], 0.23 [0.04-0.41]). Similarly, increased dose of cerebral tissue oxygen saturation desaturation would result in a loss of intelligence quotient points at 2 years with a 90% probability (posterior β estimates [80% credible interval], -0.009 [-0.016 to -0.001]). CONCLUSIONS Increased dose of cerebral tissue oxygen saturation desaturation and reduced mean cerebral tissue oxygen saturation during the early postoperative period independently increase the probability of having a lower total intelligence quotient, 2 years after PICU admission.
Collapse
Affiliation(s)
- Giorgia Carra
- All authors: Clinical Division and Laboratory of Intensive Care Medicine, Department of Cellular and Molecular Medicine, UZ Leuven and KU Leuven, Leuven, Belgium
| | | | | | | | | | | | | | | | | | | | | | | |
Collapse
|
50
|
Clark LR, Zuelsdorff M, Norton D, Johnson SC, Wyman MF, Hancock LM, Carlsson CM, Asthana S, Flowers-Benton S, Gleason CE, Johnson HM. Association of Cardiovascular Risk Factors with Cerebral Perfusion in Whites and African Americans. J Alzheimers Dis 2021; 75:649-660. [PMID: 32310160 DOI: 10.3233/jad-190360] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Midlife cardiovascular risk factors increase risk for Alzheimer's disease (AD). Despite disproportionately high cardiovascular disease and dementia rates, African Americans are under-represented in studies of AD risk and research-based guidance on targeting vascular risk factors is lacking. OBJECTIVE This study investigated relationships between specific cardiovascular risk factors and cerebral perfusion in White and African American adults enriched for AD risk. METHODS Participants included 397 cognitively unimpaired White (n = 330) and African American (n = 67) adults enrolled in the Wisconsin Alzheimer's Disease Research Center who underwent pseudo-continuous arterial spin labeling MRI. Multiple linear regression models examined independent relationships between cardiovascular risk factors and mean cerebral perfusion. Subsequent interaction and stratified models assessed the role for APOE genotype and race. RESULTS When risk factor p-values were FDR-adjusted, diastolic blood pressure was significantly associated with mean perfusion. Tobacco use, triglycerides, waist-to-hip ratio, and a composite risk score were not associated with perfusion. Without FDR adjustment, a relationship was also observed between perfusion and obesity, cholesterol, and fasting glucose. Neither APOE genotype nor race moderated relationships between risk factors and perfusion. CONCLUSION Higher diastolic blood pressure predicted lower perfusion more strongly than other cardiovascular risk factors. This relationship did not vary by racial group or genetic risk for AD, although the African American sample had greater vascular risk burden and lower perfusion rates. Our findings highlight the need to prioritize inclusion of underrepresented groups in neuroimaging studies and to continue exploring the link between modifiable risk factors, cerebrovascular health, and AD risk in underrepresented populations.
Collapse
Affiliation(s)
- Lindsay R Clark
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Megan Zuelsdorff
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,University of Wisconsin School of Nursing, Madison, WI, USA
| | - Derek Norton
- Department of Biostatistics, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Sterling C Johnson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Mary F Wyman
- Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA.,Department of Psychiatry, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Laura M Hancock
- Department of Neurology, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Cynthia M Carlsson
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Wisconsin Alzheimer's Institute, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Sanjay Asthana
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Susan Flowers-Benton
- Department of Family Medicine and Community Health, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| | - Carey E Gleason
- Wisconsin Alzheimer's Disease Research Center, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA.,Geriatric Research Education and Clinical Center, William S Middleton Memorial Veterans Hospital, Madison, WI, USA
| | - Heather M Johnson
- Division of Cardiovascular Medicine, University of Wisconsin School of Medicine and Public Health, Madison, WI, USA
| |
Collapse
|