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

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Gregori-Pla, Clara ^[1] ; Mesquita, Rickson C. ^[2] ; Favilla, Christopher G. ^[3] ; Busch, David R. ^{[4, 5]} ; Blanco, Igor ^[1] ; Zirak, Peyman ^[1] ; Frisk, Lisa Kobayashi ^[1] ; Avtzi, Stella ^[1] ; Maruccia, Federica ^{[1, 6]} ; Giacalone, Giacomo ^{[1, 7]} ; Cotta, Gianluca ^[1] ; Camps-Renom, Pol ^[8] ; Mullen, Michael T. ^[3] ; Marti-Fabregas, Joan ^[8] ; Prats-Sanchez, Luis ^[8] ; Martinez-Domeno, Alejandro ^[8] ; Kasner, Scott E. ^[3] ; Greenberg, Joel H. ^[3] ; Zhou, Chao ^[9] ; Edlow, Brian L. ^[10] ; Putt, Mary E. ^[11] ; Detre, John A. ^[3] ; Yodh, Arjun G. ^[12] ; Durduran, Turgut ^{[1, 13]} ; Delgado-Mederos, Raquel ^[8]

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^[1] Barcelona Inst Sci & Technol, ICFO Inst Ciencies Foton, Barcelona 08860 - Spain

^[2] Univ Estadual Campinas, Inst Phys, Campinas - Brazil

^[3] Univ Penn, Dept Neurol, Philadelphia, PA 19104 - USA

^[4] Univ Texas Southwestern Med Ctr Dallas, Dept Anesthesiol & Pain Management, Dallas, TX 75390 - USA

^[5] Univ Texas Southwestern Med Ctr Dallas, Dept Neurol, Dallas, TX 75390 - USA

^[6] Univ Autonoma Barcelona, Vall dHebron Univ Res Inst VHIR, Neurotraumatol & Neurosurg Res Unit UNINN, Barcelona - Spain

^[7] Ist Sci San Raffaele, Milan - Italy

^[8] Hosp Santa Creu & Sant Pau, Biomed Res Inst St Pau IIB St Pau, Dept Neurol, Stroke Unit, Barcelona - Spain

^[9] Washington Univ, McKelvey Sch Engn, St Louis, MO 63110 - USA

^[10] Massachusetts Gen Hosp, Ctr Neurotechnol & Neurorecovery, Boston, MA 02114 - USA

^[11] Univ Penn, Dept Biostat & Epidemiol, Philadelphia, PA 19104 - USA

^[12] Univ Penn, Dept Phys & Astron, Philadelphia, PA 19104 - USA

^[13] Inst Catalana Recerca & Estudis Avancats ICREA, Barcelona 08015 - Spain

• Tipo de documento: Artigo Científico
• Fonte: BMC Neurology; v. 21, n. 1 APR 9 2021.
• Citações Web of Science: 0

Resumo

Background 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 Delta CBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Methods 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. Results 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). Conclusions 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. (AU)

• Processo FAPESP: 12/02500-8 - Desenvolvimento de instrumentação e metodologias para monitoramento de oxigenação, fluxo sanguíneo e metabolismo cerebral com espectroscopias ópticas de difusão
• Beneficiário: Rickson Coelho Mesquita
• Modalidade de apoio: Auxílio à Pesquisa - Jovens Pesquisadores