Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis

Silvestrini, Mauro; Paolino, Isabella; Vernieri, Fabrizio; Baruffaldi, Roberto; Gobbi, Beatrice; Cagnetti, Claudia; Provinciali, Leandro; Bartolini, Marco

doi:10.1212/01.wnl.0000345015.35520.52

Cited by 119 publications

(99 citation statements)

References 35 publications

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“…Third, we could not observe associations of VMR and cognitive scores, even though we found overall lower scores for memory and executive functions in patients compared with HC. Here, small sample size rendered a separate evaluation of cognitive sequelae of ICA stenosis/ occlusion in dependence of the affected (left versus right) hemisphere 4 inappropriate, possibly contributing to the lack of direct association between VMR and cognitive scores. However, as we could show that unilateral decreases in cerebral VMR modulated functional networks in both the AH and UH, a more general effect of decreased VMR on cognition, irrespective of the AH, seems plausible, and direct correlations between VMR and cognitive scores may emerge in larger patient populations.…”

Section: Discussionmentioning

confidence: 99%

“…In cerebrovascular diseases, reduced VMR has been shown to be associated with higher stroke risk 3 and lower cognitive function. 4 Advanced magnetic resonance imaging (MRI) techniques have greatly improved our understanding of the relationship between brain structure, function, and blood flow. Among others, diffusion tensor imaging and blood oxygen level-dependent functional MRI that was used to assess resting-state functional connectivity (RSFC) could help explore brain function in healthy individuals 5 and in patients with cerebrovascular diseases.…”

Section: Introductionmentioning

confidence: 99%

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Cerebral Autoregulation and Brain Networks in Occlusive Processes of the Internal Carotid Artery

Avirame

Lesemann

List

et al. 2014

J Cereb Blood Flow Metab

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Patients with unilateral occlusive processes of the internal carotid artery (ICA) show subtle cognitive deficits. Decline in cerebral autoregulation and in functional and structural integrity of brain networks have previously been reported in the affected hemisphere (AH). However, the association between cerebral autoregulation, brain networks, and cognition remains to be elucidated. Fourteen neurologically asymptomatic patients (65 ± 11 years) with either ICA occlusion or high-grade ICA stenosis and 11 age-matched healthy controls (HC) (67 ± 6 years) received neuropsychologic testing, transcranial Doppler sonography to assess cerebral autoregulation using vasomotor reactivity (VMR), and magnetic resonance imaging to probe white matter microstructure and resting-state functional connectivity (RSFC). Patients performed worse on memory and executive tasks when compared with controls. Vasomotor reactivity, white matter microstructure, and RSFC were lower in the AH of the patients when compared with the unaffected hemisphere and with controls. Lower VMR of the AH was associated with several ipsilateral clusters of lower white matter microstructure and lower bilateral RSFC in patients. No correlations were found between VMR and cognitive scores. In sum, impaired cerebral autoregulation was associated with reduced structural and functional connectivity in cerebral networks, indicating possible mechanisms by which severe unilateral occlusive processes of the ICA lead to cognitive decline.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Cerebral Autoregulation and Brain Networks in Occlusive Processes of the Internal Carotid Artery

Avirame

Lesemann

List

et al. 2014

J Cereb Blood Flow Metab

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show abstract

“…12,13 The mechanisms are likely attributed to microemboli from unstable carotid plaques 5 and/or chronic hypoperfusion. 14,15 Single-arm studies of carotid revascularization accomplished by either carotid endarterectomy or CAS reported the controversial results of cognitive enhancement in patients with asymptomatic carotid stenosis. [15][16][17][18][19][20] However, there is a lack of medical-controlled evidence reflecting contemporary medical improvement and risk-benefit balance of interventions for cognitive preservation.…”

mentioning

confidence: 99%

Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis

Lin

Chang²,

Chou

et al. 2016

AJNR Am J Neuroradiol

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“…In the clinical practice, flow response to vasomotor reactivity is the standard method to infer the effects of carotid stenosis to the brain (Markus and Harrison, 1992;Müller and Schimrigk, 1996;Ratnatunga and Adiseshiah, 1990;Ringelstein et al, 1988;Silvestrini et al, 2009Silvestrini et al, , 1996Soinne et al, 2003;Vernieri et al, 1999;Widder et al, 1994). Although breath holding is not a Medical Research Archives, Vol.…”

Section: Discussionmentioning

confidence: 99%

Use of near-infrared spectroscopy to probe occlusion severity in patients diagnosed with carotid atherosclerotic disease

Forero

Novi

Avelar

et al. 2017

MRAJ

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Abstract:Atherosclerotic disease has been associated with increased risk of severe neurovascular consequences including transient ischemic attacks, ischemic strokes, and even mortality. Following the onset of carotid stenosis, the brain undergoes different compensatory mechanisms to provide adequate perfusion in order to maintain brain metabolism. In this study, we employed near-infrared spectroscopy (NIRS) to better comprehend how carotid stenosis affects cerebral hemodynamics, both at rest and during activity. Eighteen patients diagnosed with atherosclerotic disease were recruited for a protocol consisting of resting state and vasoreactivity testing performed with breath holding. Although the breath holding challenge induced global vasodilation in all patients, the extent of dilation varied according to the level of stenosis. Patients diagnosed with carotid stenosis have impaired hemodynamic response, with a median 77% vasoreactivity in the hemisphere ipsilateral to the stenotic vessel when compared to the healthy hemisphere. Hemodynamics of these patients differed at rest, with 33% fewer network links in the hemisphere ipsilateral to the stenosis than the healthy hemisphere. On the other hand, hemodynamic patterns were more heterogeneous with patients diagnosed with a carotid occlusion, which correlates with the opening of collateral circulation. Overall, our results suggest that NIRS can open new directions to the investigation of the effects of cerebrovascular atherosclerotic disease.

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Cerebral hemodynamics and cognitive performance in patients with asymptomatic carotid stenosis

Cited by 119 publications

References 35 publications

Cerebral Autoregulation and Brain Networks in Occlusive Processes of the Internal Carotid Artery

Cerebral Autoregulation and Brain Networks in Occlusive Processes of the Internal Carotid Artery

Intervention versus Aggressive Medical Therapy for Cognition in Severe Asymptomatic Carotid Stenosis

Use of near-infrared spectroscopy to probe occlusion severity in patients diagnosed with carotid atherosclerotic disease

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