Impaired Cerebral Autoregulation Is Associated with Brain Atrophy and Worse Functional Status in Chronic Ischemic Stroke

Aoi, Mikio C.; Hu, Kun; Lo, Men-Tzung; Selim, Magdy; Olufsen, Mette S.; Novak, Vera

doi:10.1371/journal.pone.0046794

Cited by 57 publications

(49 citation statements)

References 59 publications

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“…For example, systemic circulatory or autonomic dysfunction-induced attenuation in ECA regulation may exacerbate intracranial cerebral blood flow regulation. This has important clinical implications given that impaired CA is associated with poor clinical outcome, e.g., brain atrophy and cognitive dysfunction, following ischemic stroke and brain injury, and may also predispose to neurodegenerative disease (2,3). Collectively, the present findings provide mechanistic insight into how impaired systemic circulatory and autonomic function can translate into regional brain disease.…”

Section: Perspectives and Significancementioning

confidence: 62%

Regional redistribution of blood flow in the external and internal carotid arteries during acute hypotension

Ogoh

Lericollais

Hirasawa

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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The present study examined to what extent an acute bout of hypotension influences blood flow in the external carotid artery (ECA) and the corresponding implications for blood flow regulation in the internal carotid artery (ICA). Nine healthy male participants were subjected to an abrupt decrease in arterial pressure via the thigh-cuff inflation-deflation technique. Duplex ultrasound was employed to measure beat-to-beat ECA and ICA blood flow. Compared with the baseline normotensive control, acute hypotension resulted in a heterogeneous blood flow response. ICA blood flow initially decreased following cuff release and then returned quickly to baseline levels. In contrast, the reduction in ECA blood flow persisted for 30 s following cuff release. Thus, the contribution of common carotid artery blood flow to the ECA circulation decreased during acute hypotension (-10 ± 4%, P < 0.001). This finding suggests that a preserved reduction in ECA blood flow, as well as dynamic cerebral autoregulation likely prevent a further decrease in intracranial blood flow during acute hypotension. The peripheral vasculature of the ECA may, thus, be considered an important vascular bed for intracranial cerebral blood flow regulation.

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Section: Perspectives and Significancementioning

confidence: 62%

Regional redistribution of blood flow in the external and internal carotid arteries during acute hypotension

Ogoh

Lericollais

Hirasawa

et al. 2014

American Journal of Physiology-Regulatory, Integrative and Comp

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show abstract

“…Hypertension is linked with ischemic injury (e.g., white matter hyperintensities) that often leads to brain shrinkage. 52-55 Cerebral hypoperfusion accelerates brain atrophy in medical and neurological populations 8,56,57 and recent work demonstrates its association with cortical thickness in older adults. 30 Nevertheless, the effects of hypertension on cortical thickness was attenuated after age was entered as covariate.…”

Section: Discussionmentioning

confidence: 99%

The impact of hypertension on cerebral perfusion and cortical thickness in older adults

Alosco

Gunstad

et al. 2014

Journal of the American Society of Hypertension

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Background Hypertension may increase risk for dementia possibly because of its association with decreased cortical thickness. Disturbed cerebral autoregulation is one plausible mechanism by which hypertension impacts the cerebral structure, but the associations among hypertension, brain perfusion, and cortical thickness are poorly understood. Methods The current sample consisted of 58 older adults with varying levels of vascular disease. Diagnostic history of hypertension and antihypertensive medication status was ascertained through self-report and, when available, confirmed by medical record review. All participants underwent arterial spin labeling and T1-weighted magnetic resonance imaging (MRI) to quantify total and regional cortical perfusion and thickness. Results Analysis of covariance adjusting for medical variables showed that participants with hypertension exhibited reduced temporal and occipital brain perfusion as well as total and regional cortical thickness relative to those without hypertension. The effects of hypertension on total brain perfusion remained unchanged even after adjustment for age, though no such pattern emerged for cortical thickness. Decreased total brain perfusion predicted reduced thickness of the total brain as well as of the frontal, temporal, and parietal lobe cortices. Antihypertensive treatment was not associated with total cerebral perfusion or cortical thickness. Discussion This study provides initial evidence for the adverse effects of a diagnostic history of hypertension on brain hypoperfusion and reduced cortical thickness. Longitudinal studies are needed to investigate the role of hypertension and its interaction with other contributing factors (e.g., age) in the manifestation of cerebral hypoperfusion and reduced cortical thickness.

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“…One study indicated that better bilateral dynamic CA is associated with less atrophy and better long-term functional status in older adults with chronic ischaemic infarctions 3. The other showed that impairment of dynamic CA ipsilateral to acute ischaemic stroke is associated with larger infarction, and dysautoregulation tends to worsen and spread to the contralateral side over the first days poststroke and is associated with poor clinical outcome 4.…”

Section: Clinical Applications Of Ca Studies In Strokementioning

confidence: 99%

Impaired cerebral autoregulation: measurement and application to stroke

Xiong

Liu

Shang

et al. 2017

J Neurol Neurosurg Psychiatry

121

100

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Cerebral autoregulation (CA) is a protective mechanism that maintains cerebral blood flow at a relatively constant level despite fluctuations of cerebral perfusion pressure or arterial blood pressure. It is a universal physiological mechanism that may involve myogenic, neural control as well as metabolic regulations of cerebral vasculature in response to changes in pressure or cerebral blood flow. Traditionally, CA has been represented by a sigmoid curve with a wide plateau between about 50 mm Hg and 170 mm Hg of steady-state changes in mean arterial pressure, defined as static CA. With the advent of transcranial Doppler, measurement of cerebral blood flow in response to transient changes in arterial pressure has been used to assess dynamic CA. However, a gold standard for measuring CA is not currently available. Stroke has been the leading cause of long-term adult disability throughout the world. A better understanding of CA and its response to pathological derangements can help assess the severity of stroke, guide management decisions, assess response to interventions and provide prognostic information. The objective of this review is to provide a comprehensive insight about physiology of autoregulation, measurement methodologies and clinical applications in stroke to help build a consensus for what should be included in an internationally agreed protocol for CA testing and monitoring, and to promote its translation into clinical bedside practice for stroke management.

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Impaired Cerebral Autoregulation Is Associated with Brain Atrophy and Worse Functional Status in Chronic Ischemic Stroke

Cited by 57 publications

References 59 publications

Regional redistribution of blood flow in the external and internal carotid arteries during acute hypotension

Regional redistribution of blood flow in the external and internal carotid arteries during acute hypotension

The impact of hypertension on cerebral perfusion and cortical thickness in older adults

Impaired cerebral autoregulation: measurement and application to stroke

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