Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease
Por:
Gregori-Pla, C, Mesquita, RC, Favilla, CG, Busch, DR, Blanco, I, Zirak, P, Frisk, LK, Avtzi, S, Maruccia, F, Giacalone, G, Cotta, G, Camps-Renom, P, Mullen, MT, Marti-Fabregas, J, Prats-Sanchez, L, Martinez-Domeno, A, Kasner, SE, Greenberg, JH, Zhou, C, Edlow, BL, Putt, ME, Detre, JA, Yodh, AG, Durduran, T, Delgado-Mederos, R
Publicada:
9 abr 2021
Resumen:
Background The 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 Delta CBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Methods Transcranial 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. Results After 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). Conclusions The 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.
Filiaciones:
Gregori-Pla, C:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Mesquita, RC:
Univ Estadual Campinas, Inst Phys, Campinas, Brazil
Favilla, CG:
Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
Busch, DR:
Univ Texas Southwestern Med Ctr Dallas, Dept Anesthesiol & Pain Management, Dallas, TX 75390 USA
Univ Texas Southwestern Med Ctr Dallas, Dept Neurol, Dallas, TX 75390 USA
Blanco, I:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Zirak, P:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Frisk, LK:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Avtzi, S:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Maruccia, F:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Univ Autonoma Barcelona, Vall dHebron Univ Res Inst VHIR, Neurotraumatol & Neurosurg Res Unit UNINN, Barcelona, Spain
Giacalone, G:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Ist Sci San Raffaele, Milan, Italy
Cotta, G:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Camps-Renom, P:
Hosp Santa Creu & Sant Pau, Biomed Res Inst St Pau IIB St Pau, Dept Neurol, Stroke Unit, Barcelona, Spain
Mullen, MT:
Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
Marti-Fabregas, J:
Hosp Santa Creu & Sant Pau, Biomed Res Inst St Pau IIB St Pau, Dept Neurol, Stroke Unit, Barcelona, Spain
Prats-Sanchez, L:
Hosp Santa Creu & Sant Pau, Biomed Res Inst St Pau IIB St Pau, Dept Neurol, Stroke Unit, Barcelona, Spain
Martinez-Domeno, A:
Hosp Santa Creu & Sant Pau, Biomed Res Inst St Pau IIB St Pau, Dept Neurol, Stroke Unit, Barcelona, Spain
Kasner, SE:
Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
Greenberg, JH:
Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
Zhou, C:
Washington Univ, McKelvey Sch Engn, St Louis, MO 63110 USA
Edlow, BL:
Massachusetts Gen Hosp, Ctr Neurotechnol & Neurorecovery, Boston, MA 02114 USA
Putt, ME:
Univ Penn, Dept Biostat & Epidemiol, Philadelphia, PA 19104 USA
Detre, JA:
Univ Penn, Dept Neurol, Philadelphia, PA 19104 USA
Yodh, AG:
Univ Penn, Dept Phys & Astron, Philadelphia, PA 19104 USA
Durduran, T:
Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860, Spain
Inst Catalana Recerca & Estudis Avancats ICREA, Barcelona 08015, Spain
Delgado-Mederos, R:
Hosp Santa Creu & Sant Pau, Biomed Res Inst St Pau IIB St Pau, Dept Neurol, Stroke Unit, Barcelona, Spain
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