Clinical factors associated with cerebral autoregulation in ischemic stroke related to small artery occlusion

Abstract

Background Existing data suggest that cerebral autoregulation (CA) varies among different subtypes of ischaemic stroke. CA is globally impaired in patients with small artery occlusion (SAO). However, the factors influencing CA impairment in patients remains to be elucidated. Methods Stroke patients with SAO who underwent brain magnetic resonance imaging (MRI) were prospectively studied. Within 7 days after stroke onset, CA was recorded from the middle cerebral artery blood flow velocity and arterial blood pressure was simultaneously measured. Transfer function analysis was used to derive CA parameters, including gain and phase. Clinical characteristics, mean arterial pressure (MAP), biochemical findings, and cerebral small vessel disease (CSVD) markers on MRI were assessed in each patient. Factors associated with CA parameters were investigated. Univariate and multivariate linear regression analyses were conducted to determine the relationship between clinical factors and CA parameters. Results Sixty-three SAO patients (age, 56.3 ± 9.9 years; 55 men) were enrolled in the study. In the multiple linear regression analysis, after controlling for relevant clinical factors, MAP on admission (ipsilateral OR = 0.99 and contralateral OR = 0.99, both P < 0.005) was a significant independent predictor of bilateral gain. MAP > 105 mmHg on admission (OR = 0.77, P = 0.019) was significantly associated with ipsilateral gain. Diabetes mellitus was a significant predictive factor for bilateral gain (ipsilateral OR = 1.32 and contralateral OR = 1.22, both P < 0.005). No correlations were found between CA parameters and CSVD characteristics. Conclusion In SAO-related ischaemic stroke, patients with MAP > 105 mmHg on admission tended to have better ipsilateral CA. Diabetes mellitus appears to be an independent risk factor for CA impairment in patients with SAO-related stroke. CSVD may not be the main factor affecting bilateral CA in patients with SAO.

Associations of Cerebrovascular Regulation and Arterial Stiffness With Cerebral Small Vessel Disease: A Systematic Review and Meta‐Analysis

“…Guo et al 102 extended the findings from these studies by following up the patients after initial cross‐sectional analysis and demonstrated that the observation of impaired cerebral autoregulation in the groups with cSVD was diffuse and persisted for 6 months after the initial lacunar infarction. Contrary to most studies included, both Wu et al 106 and Xiong et al 105 reported no association between cerebral autoregulation and any radiological markers of cSVD. However, both studies used approaches to determining cerebral autoregulation that differed from those previously discussed.…”

“…All 102 , 103 , 104 , 107 , 108 , 109 , 110 , 111 , 112 , 114 , 115 but 3 105 , 106 , 113 studies demonstrated a significant association between cerebral autoregulation impairments and greater cSVD burden. Six studies were case–control studies 102 , 103 , 105 , 107 , 108 , 113 and 8 studies were prospective or retrospective cohort studies.…”

“…Abstract screening and exclusion of nonoriginal research, records lacking full text, or records that did not quantitatively assess a relationship between cerebral autoregulation and cSVD resulted in 14 publications for systematic review. Of the 14 articles, 4 assessed recent small subcortical infarcts, 102 , 103 , 104 , 105 1 assessed the presence of lacunes, 106 2 assessed enlarged perivascular spaces, 106 , 107 3 assessed cerebral microbleeds, 106 , 107 , 108 8 assessed white matter hyperintensities, 106 , 107 , 109 , 110 , 111 , 112 , 113 , 114 and 4 assessed the total cSVD score. 106 , 107 , 110 , 115 All included studies were cross‐sectional in design.…”

“…Of the 14 articles, 4 assessed recent small subcortical infarcts, 102 , 103 , 104 , 105 1 assessed the presence of lacunes, 106 2 assessed enlarged perivascular spaces, 106 , 107 3 assessed cerebral microbleeds, 106 , 107 , 108 8 assessed white matter hyperintensities, 106 , 107 , 109 , 110 , 111 , 112 , 113 , 114 and 4 assessed the total cSVD score. 106 , 107 , 110 , 115 All included studies were cross‐sectional in design. The total population consisted of healthy/aging individuals with or without vascular risk factors (57% of included studies), previously diagnosed cSVD (36%), cerebrovascular events (36%), and patients undergoing cardiac surgery (7%).…”

“…Six studies were case–control studies 102 , 103 , 105 , 107 , 108 , 113 and 8 studies were prospective or retrospective cohort studies. 104 , 106 , 109 , 110 , 111 , 112 , 114 , 115 In a study of 346 patients undergoing cardiopulmonary bypass, Nomura et al 110 reported that cSVD was associated with a 3‐fold greater odds of impaired cerebral autoregulation. Liu et al 107 analyzed 113 patients with cSVD and 83 cSVD‐free controls and similarly found a significantly reduced cerebral autoregulation in the patients with cSVD.…”