Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease

BMC Neurology

Brian L. Edlow¹  Mary E. Putt²  Pol Camps-Renom³  Alejandro Martínez-Domeño³  Joan Martí-Fàbregas³  Luís Prats-Sánchez³  Raquel Delgado-Mederos³  Christopher G. Favilla⁴  John A. Detre⁴  Scott E. Kasner⁴  Michael T. Mullen⁴  Joel H. Greenberg⁴  Arjun G. Yodh⁵  David R. Busch⁶  Gianluca Cotta⁷  Igor Blanco⁷  Peyman Zirak⁷  Lisa Kobayashi Frisk⁷  Clara Gregori-Pla⁷  Stella Avtzi⁷  Turgut Durduran⁸  Federica Maruccia⁹  Giacomo Giacalone^1,10  Rickson C. Mesquita^1,11  Chao Zhou^1,12 

[1] Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital, Boston, MA, USA;Department of Biostatistics and Epidemiology, University of Pennsylvania, Philadelphia, USA;Department of Neurology (Stroke Unit). Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau), Barcelona, Spain;Department of Neurology, University of Pennsylvania, Philadelphia, USA;Department of Physics and Astronomy, University of Pennsylvania, Philadelphia, USA;Departments of Anesthesiology and Pain Management and Neurology, University of Texas Southwestern Medical Center, Dallas, USA;ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860, Castelldefels, Barcelona, Spain;ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860, Castelldefels, Barcelona, Spain;Institució Catalana de Recerca i Estudis Avançats (ICREA), 08015, Barcelona, Spain;ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860, Castelldefels, Barcelona, Spain;Neurotraumatology and Neurosurgery Research Unit (UNINN), Vall d’Hebron University Research Institute (VHIR), Universitat Autònoma de Barcelona, Barcelona, Spain;ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology, 08860, Castelldefels, Barcelona, Spain;San Raffaele Scientific Institute, Milan, Italy;Institute of Physics, University of Campinas, Campinas, Brazil;McKelvey School of Engineering, Washington University in St. Louis, St. Louis, MO, USA;

关键词: Cerebrovascular disease;    Mean arterial pressure;    Cerebral blood flow;    Cerebral autoregulation;    Diffuse correlation spectroscopy;    Diffuse optics;   

DOI  :  10.1186/s12883-021-02179-8

来源: Springer

【 摘 要 】

BackgroundThe cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow.MethodsTranscranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol.ResultsAfter elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p < 0.001) or ICA stenosis (8.6% [3.1,14.0], p = 0.003)). MAP in AIS patients did not return to baseline values (2.6 mmHg [0.5, 4.7], p = 0.018), but in ICA stenosis patients and controls did. Instead ipsilesional but not contralesional CBF was correlated with MAP (AIS 6.0%/mmHg [− 2.4,14.3], p = 0.038; ICA stenosis 11.0%/mmHg [2.4,19.5], p < 0.001).ConclusionsThe observed associations between ipsilateral CBF and MAP suggest that short HOB position changes may elicit deficits in cerebral autoregulation in cerebrovascular disorders. Additional research is required to further characterize this phenomenon.

【 授权许可】

CC BY