Cerebral Small Vessel, But Not Large Vessel Disease, Is Associated With Impaired Cerebral Autoregulation During Cardiopulmonary Bypass: A Retrospective Cohort Study

Nomura, Yohei; Faegle, Roland; Hori, Daijiro; Al-Qamari, Abbas; Nemeth, Alexander J.; Gottesman, Rebecca F.; Yenokyan, Gayane; Brown, Charles H.; Hogue, Charles W.

doi:10.1213/ane.0000000000003384

Cited by 26 publications

(24 citation statements)

References 39 publications

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“…Cerebral SVD contributes to a wide range of pathological processes, which affect the small vessels including small arteries, arterioles, venules, and capillaries in the brain (Østergaard et al, 2016;Staszewski et al, 2017;Parkes et al, 2018). In contrast, large vessel disease in the brain may result in stroke and hemorrhage, which affect various type of arteries (Nomura et al, 2018). Table 2 provides the roles of CNS pericytes in health and disease focusing on cerebrovascular diseases and AD.…”

Section: Pathological Roles Of Pericytes In Cerebrovascular Diseases mentioning

confidence: 99%

Brain Microvascular Pericytes in Vascular Cognitive Impairment and Dementia

Uemura

Maki

Ihara

et al. 2020

Front. Aging Neurosci.

170

112

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Pericytes are unique, multi-functional mural cells localized at the abluminal side of the perivascular space in microvessels. Originally discovered in 19th century, pericytes had drawn less attention until decades ago mainly due to lack of specific markers. Recently, however, a growing body of evidence has revealed that pericytes play various important roles: development and maintenance of blood-brain barrier (BBB), regulation of the neurovascular system (e.g., vascular stability, vessel formation, cerebral blood flow, etc.), trafficking of inflammatory cells, clearance of toxic waste products from the brain, and acquisition of stem cell-like properties. In the neurovascular unit, pericytes perform these functions through coordinated crosstalk with neighboring cells including endothelial, glial, and neuronal cells. Dysfunction of pericytes contribute to a wide variety of diseases that lead to cognitive impairments such as cerebral small vessel disease (SVD), acute stroke, Alzheimer's disease (AD), and other neurological disorders. For instance, in SVDs, pericyte degeneration leads to microvessel instability and demyelination while in stroke, pericyte constriction after ischemia causes a no-reflow phenomenon in brain capillaries. In AD, which shares some common risk factors with vascular dementia, reduction in pericyte coverage and subsequent microvascular impairments are observed in association with white matter attenuation and contribute to impaired cognition. Pericyte loss causes BBB-breakdown, which stagnates amyloid β clearance and the leakage of neurotoxic molecules into the brain parenchyma. In this review, we first summarize the characteristics of brain microvessel pericytes, and their roles in the central nervous system. Then, we focus on how dysfunctional pericytes contribute to the pathogenesis of vascular cognitive impairment including cerebral 'small vessel' and 'large vessel' diseases, as well as AD. Finally, we discuss therapeutic implications for these disorders by targeting pericytes.

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Section: Pathological Roles Of Pericytes In Cerebrovascular Diseases mentioning

confidence: 99%

Brain Microvascular Pericytes in Vascular Cognitive Impairment and Dementia

Uemura

Maki

Ihara

et al. 2020

Front. Aging Neurosci.

170

112

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“…Magnetic resonance imaging (MRI), as compared to transcranial Doppler, is a suitable method for assessing SCVDs in a community-based sample given its noninvasive nature and its superiority in assessing intracranial arterial stenosis (ICAS) 9 ) . In MRI of the brain, cerebral small-vessel diseases often manifest as lacunar infarction, white matter lesions, and microbleeds 7 ) , whereas large-vessel diseases, such as ICAS, are detected as stenotic lesions of major cerebral arteries 10 ) .…”

Section: Introductionmentioning

confidence: 99%

The Association Between Coronary Artery Calcification and Subclinical Cerebrovascular Diseases in Men: An Observational Study

Khan

Fujiyoshi

Shiino

et al. 2020

JAT

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The official journal of the Japan Atherosclerosis Society and the Asian Pacific Society of Atherosclerosis and Vascular Diseases Original Article Aim: Coronary artery calcification (CAC) is an independent predictor of stroke and dementia, in which subclinical cerebrovascular diseases (SCVDs) play a vital pathogenetic role. However, few studies have described the association between CAC and SCVDs. Therefore, the aim of this study was to assess the clinical relationship between CAC and SCVDs in a healthy Japanese male population. Methods: In this observational study, 709 men, free of stroke, were sampled from a city in Japan from 2010 to 2014. CAC was scored using the Agatston method. The following SCVDs were assessed using magnetic resonance imaging: intracranial arterial stenosis (ICAS), lacunar infarction, deep and subcortical white matter hyperintensity (DSWMH), periventricular hyperintensity (PVH), and microbleeds. The participants were categorized according to CAC scores as follows: no CAC (0), mild CAC (1-100), and moderate-to-severe CAC (100). The adjusted odds ratios of prevalent SCVDs were computed in reference to the no-CAC group using logistic regression. Results: The mean (standard deviation) age of the participants was 68 (8.4) years. Participants in the moderateto-severe-CAC category showed significantly higher odds of prevalent lacunar infarction, DSWMH, and ICAS in age-adjusted and risk-factor-adjusted models. Microbleeds and PVH, in contrast, did not show any significant associations. The trends for CAC with lacunar infarction, DSWMH, and ICAS were also significant (all P-values for trend ≤ 0.02). Conclusions: Higher CAC scores were associated with higher odds of lacunar infarction, DSWMH, and ICAS. The presence and degree of CAC may be a useful indicator for SCVDs involving small and large vessels. dementia 3). Subclinical cerebrovascular diseases (SCVDs), involving both small and large vessels, are likely to play an important role in the pathogenesis of stroke and dementia 4, 5). The speculated mechanism for CAC to predict stroke and dementia is the coexis-Copyright©2020 Japan Atherosclerosis Society This article is distributed under the terms of the latest version of CC BY-NC-SA defined by the Creative Commons Attribution License.

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“…48 We have found a relationship between the cerebral white matter disease determined with brain magnetic resonance imaging, an indicator of cerebral small vessel disease, and impaired cerebral blood flow autoregulation. 49 Thus, although patients may variably tolerate blood pressure lower than the lower limit of autoregulation or higher than the upper limit of autoregulation, particularly if of brief duration, precisely knowing these cutoff in the operating room or ICU would seem more precise for managing blood pressure than population-based summary estimates.…”

Section: Clinical Approach To Defining Hypotensionmentioning

confidence: 99%