Therapeutisch induzierte Arteriogenese im Gehirn

Busch, Hans-Jörg; Buschmann, Ivo; Schneeloch, Edda; Bode, Christoph; Mies, Günter; Hossmann, K.‐A.

doi:10.1007/s00115-005-1988-4

Cited by 5 publications

(1 citation statement)

References 39 publications

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“…[16][17][18][19] Busc et al found that CVR can be improved and the occurrence of cerebral infarction can be prevented through the formation of intracranial collateral arteries in the mouse model of chronic ischemia. [20] Based on DSA in this case, the patient had abundant vascular compensation of the posterior circulation on the right side of the brain and regenerative moyamoya vessels in the brain base, indicating a less severe degree of CVR impairment on the right side, consistent with the preoperative HVT-SPECT results. In addition, hemispheric steal phenomenon may also explain the left-right difference in CVR.…”

Section: Discussionsupporting

confidence: 76%

How to choose the surgical side when cerebral blood flow and cerebrovascular response are contradictory in bilateral moyamoya disease?: A case report

Luo

Xin

et al. 2022

Medicine

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Introduction: Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive occlusion of the internal carotid artery and the secondary formation of collateral vessels. Bypass surgery is an effective treatment for MMD. Comprehensive evaluation of cerebral blood flow (CBF) and cerebrovascular response (CVR) is the common hemodynamic indication to surgery, the changes of which are usually identical. The patient’s main concerns and important examinations: We reported a rare case of MMD in a 34-year-old pregnant woman with transient ischemic attacks (TIAs) for 1 month, manifesting as frequent weakness in right limbs for several minutes without obvious cause. The diagnostic digital subtraction angiography (DSA) examination revealed Suzuki Grade I in left side and Grade IV in right side under modified Suzuki scoring. No-hyperventilation test single-photon emission computed tomography (no-HVT SPECT) showed more decreased CBF in the right side of the brain, but HVT SPECT demonstrated a more impaired CVR on the left side. Comprehensively, which side should be operated on is confusing when the changes of CVR and CBF are inconsistent. The main diagnosis, therapeutics interventions, and outcomes: The patient was diagnosed with bilateral MMD and underwent combined bypass surgery on the left side of the brain. The symptoms of admission were completely relieved after surgery and there were no further cerebrovascular events during the follow-up period of 4 months. Conclusion: CVR is a primary surgical indication of MMD, especially when the impairment of CVR and CBF are not consistent in the ipsilateral hemisphere. Meanwhile, HVT is the vital vasoactive challenges test for measuring CVR in MMD.

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Section: Discussionsupporting

confidence: 76%

How to choose the surgical side when cerebral blood flow and cerebrovascular response are contradictory in bilateral moyamoya disease?: A case report

Luo

Xin

et al. 2022

Medicine

View full text Add to dashboard Cite

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The mechanisms of brain ischemic insult and potential protective interventions

Guo

Wang

2009

Neurosci. Bull.

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Abstract:The mechanisms of brain ischemic insult include glutamate excitoxicity, calcium toxicity, free radicals, nitric oxide, inflammatory reactions, as well as dysfunctions of endoplasmic reticulum and mitochondrion. These injury cascades are interconnected in complex ways, thus it is hard to compare their pathogenic importances in ischemia models. And the research in cellular and molecular pathways has spurred the studies in potential neuroprotections mainly in pharmacological fields, such as anti-excitotoxic treatment, calcium-channel antagonism, approaches for inhibition of oxidation, inflammation and apoptosis, etc. Besides, other protective interventions including thrombolysis, arteriogenesis, regeneration therapy, and ischemia preconditioning or postconditioning, are also under investigations. Despite the present difficulties, we are quite optimistic towards future clinical applications of neuroprotective agents, by optimizing experimental approaches and clinical trials.Key words: brain ischemia; glutamate receptors; calcium toxicity; endoplasmic reticulum stress; neuroprotection 1 Brain ischemia 1.1 Definition What's brain ischemia? Is it the reduction of cerebral blood flow (CBF)? The answer is "No". The analysis of the correlation between early local blood flow and histological infarct frequency showed that the likelihood of infarction was at zero [1] or low (probably less than 5%) [2] in animals or patients, respectively, when early CBF remained above 50% of that in control.During the initial hours of vascular occlusion, the metabolic and ionic disturbances in the periphery of focal ischemia proceed at widely varying flow thresholds ( Fig.1) in the following order: firstly protein synthesis is inhibited at a threshold of about 0.55 mL/(g·min) followed by a stimulation of anaerobic glycolysis below 0.35 mL/(g·min), a breakdown of energy state at about 0.20 mL/(g·min) and anoxic depolarizations of the cell membranes below 0.15 mL/(g·min) [3] .The two different thresholds of hypoxia for the preservations of functional and structural integrities were identified by Symon et al. [4] . The higher threshold is at approximately 35% of normal CBF, and the lower one is at approximately 25-20% of normal ( Fig.1). The ischemic penumbraLike a half-shaded zone surrounding a solar eclipse, the penumbra lies peripherally to the core zone of a focal ischemic lesion, and possesses important features: summarily, the substantial initial size, which amounts to about one half of the entire early ischemic lesion; the narrow range of perfusion, which makes the penumbra precariously sensitive to small changes of perfusion pressure; the electrophysiologically dynamic property, which enables penumbra to undergo recurrent energy-consuming depolarizations ; and finally the metabolical instability with severe metabolism/flow dissociation.As a result of these factors, the penumbra clearly has a limited life span and appears to undergo irreversible injury within a few hours unless reperfusion is initiated and/or 140 Neurosci Bull J...

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Role of endothelial nitric oxide synthetase in arteriogenesis after stroke in mice

et al. 2009

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Arteriogenesis supports restored perfusion in the ischemic brain and improves long-term functional outcome after stroke. We investigate the role of endothelial nitric oxide synthetase (eNOS) and an NO donor, [(Z)-1-[N-(2-aminoethyl)-N-(2-ammonioethyl) aminio] diazen-1-ium-1, 2-diolate (DETA-NONOate), in promoting arteriogenesis after stroke. Adult wild-type (WT, n=18) and eNOS-knockout (eNOS-/-, n=36) mice were subjected to transient (2.5 hours) right middle cerebral artery occlusion (MCAo) and were treated with or without DETA-NONOate (0.4 mg/kg) 24 hours after MCAo. Functional evaluation was performed. Animals were sacrificed 3 days after MCAo for arterial cell culture studies, or 14 days for immunohistochemical analysis. Consistent with previous studies, eNOS-/- mice exhibited a higher mortality rate (p<0.05, n=18/group) and more severe neurological functional deficit after MCAo than WT mice (p<0.05, n=12/group). Decreased arteriogenesis, was evident in eNOS-/- mice compared with WT mice, as demonstrated by reduced vascular smooth muscle cell (VSMC) proliferation, arterial density and diameter in the ischemic brain. eNOS-/- mice treated with DETA-NONOate had a significantly decreased mortality rate and improved functional recovery, and exhibited enhanced arteriogenesis identified by increased VSMC proliferation, and upregulated arterial density and diameter compared to eNOS-/- mice after stroke (p<0.05, n=12/group). To elucidate the mechanisms underlying eNOS/NO mediated arteriogenesis, VSMC migration was measured in vitro. Arterial cell migration significantly decreased in the cultured common carotid artery (CCA) derived from eNOS-/- mice 3 days after MCAo compared to WT arterial cells. DETA-NONOate-treatment significantly attenuated eNOS-/--induced decrease of arterial cell migration compared to eNOS-/- control artery (p<0.05. n=6/group). Using VSMC culture, DETA-NONOate significantly increased VSMC migration, while inhibition of NOS significantly decreased VSMC migration (p<0.05. n=6/group). Our data indicated that eNOS not only promotes vascular dilation but also increases VSMC proliferation and migration, and thereby enhances arteriogenesis after stroke. Therefore, increase eNOS may play an important role in regulating of arteriogenesis after stroke.

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Therapeutisch induzierte Arteriogenese im Gehirn

Cited by 5 publications

References 39 publications

How to choose the surgical side when cerebral blood flow and cerebrovascular response are contradictory in bilateral moyamoya disease?: A case report

How to choose the surgical side when cerebral blood flow and cerebrovascular response are contradictory in bilateral moyamoya disease?: A case report

The mechanisms of brain ischemic insult and potential protective interventions

Role of endothelial nitric oxide synthetase in arteriogenesis after stroke in mice

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