Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease

The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associat...

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Detalles Bibliográficos
Autores: Gregori-Pla, Clara|||0000-0002-6623-0031, Mesquita, Rickson C., Favilla, Christopher G., Busch, David R., Blanco, Igor|||0000-0001-7636-1177, Zirak, Peyman|||0000-0002-0331-6292, Frisk, Lisa Kobayashi, Avtzi, Stella|||0000-0002-8893-3969, Maruccia, Federica|||0000-0002-3774-7875, Giacalone, Giacomo, Cotta, Gianluca, Camps-Renom, Pol|||0000-0001-6587-6271, Mullen, Michael T., Martí-Fàbregas, Joan|||0000-0001-9229-8649, Prats Sánchez, Luis Antonio|||0000-0002-3192-4631, Martínez-Domeño, Alejandro|||0000-0002-9933-3192, Kasner, Scott E., Greenberg, Joel H., Zhou, Chao, Edlow, Brian L., Putt, Mary E., Detre, John A., Yodh, Arjun G., Durduran, Turgut|||0000-0001-5838-1027, Delgado Mederos, Raquel|||0000-0003-3737-7226
Tipo de recurso: artículo
Fecha de publicación:2021
País:España
Institución:Universitat Autònoma de Barcelona
Repositorio:Dipòsit Digital de Documents de la UAB
Idioma:inglés
OAI Identifier:oai:ddd.uab.cat:255451
Acceso en línea:https://ddd.uab.cat/record/255451
https://dx.doi.org/urn:doi:10.1186/s12883-021-02179-8
Access Level:acceso abierto
Palabra clave:Cerebrovascular disease
Mean arterial pressure
Cerebral blood flow
Cerebral autoregulation
Diffuse correlation spectroscopy
Diffuse optics
Descripción
Sumario:The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Transcranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol. After elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p < 0.001) or ICA stenosis (8.6% [3.1,14.0], p = 0.003)). MAP in AIS patients did not return to baseline values (2.6 mmHg [0.5, 4.7], p = 0.018), but in ICA stenosis patients and controls did. Instead ipsilesional but not contralesional CBF was correlated with MAP (AIS 6.0%/mmHg [- 2.4,14.3], p = 0.038; ICA stenosis 11.0%/mmHg [2.4,19.5], p < 0.001). The observed associations between ipsilateral CBF and MAP suggest that short HOB position changes may elicit deficits in cerebral autoregulation in cerebrovascular disorders. Additional research is required to further characterize this phenomenon. The online version contains supplementary material available at 10.1186/s12883-021-02179-8.

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