Georgios Tsivgoulis1, Andrei V Alexandrov. 1. Comprehensive Stroke Center, University of Alabama at Birmingham Hospital, Birmingham, AL (GT, AVA) and Department of Neurology, University of Athens, Athens, Greece (GT).
Abstract
BACKGROUND: The capacity of the brain to regulate its blood flow in order to meet metabolic demands and to compensate for acute and chronic changes in cerebral perfusion pressure (cerebral autoregulation) is an essential protecting mechanism against cerebral ischemia. METHODS: We reviewed existing data on methods of assessing cerebral blood flow and autoregulation. RESULTS: Cerebral autoregulation is mechanistically complex and depends on myogenic, neuronal, endothelial, and metabolic factors. There are numerous methods of estimating cerebrovascular reserve (CVR) non-invasively including Positive Emission Tomography (gold standard), Transcranial Doppler ultrasound, dynamic contrast-enhanced perfusion Magnetic Resonance Imaging, Single-Photon Emission Computed Tomography and Xenon Computed Tomography. Since each of these techniques has its advantages and disadvantages, selection of a specific method for CVR testing depends on availability, acquired experience in interpreting the study, required precision, and cost. Cerebral autoregulation may be impaired in patients with symptomatic or asymptomatic carotid stenosis or occlusion and is associated with a higher risk of stroke or transient ischemic attack (TIA) ipsilateral to the carotid artery disease. CONCLUSION: Assessment of CVR can help stratify patients based on their risk of stroke or TIA and select patients who may benefit from revascularization therapies. Cerebral vasoreactivity testing may be useful to evaluate cerebral autoregulation after revascularization procedures as a surrogate endpoint of vascular events related to hypoperfusion or hyperperfusion.
BACKGROUND: The capacity of the brain to regulate its blood flow in order to meet metabolic demands and to compensate for acute and chronic changes in cerebral perfusion pressure (cerebral autoregulation) is an essential protecting mechanism against cerebral ischemia. METHODS: We reviewed existing data on methods of assessing cerebral blood flow and autoregulation. RESULTS: Cerebral autoregulation is mechanistically complex and depends on myogenic, neuronal, endothelial, and metabolic factors. There are numerous methods of estimating cerebrovascular reserve (CVR) non-invasively including Positive Emission Tomography (gold standard), Transcranial Doppler ultrasound, dynamic contrast-enhanced perfusion Magnetic Resonance Imaging, Single-Photon Emission Computed Tomography and Xenon Computed Tomography. Since each of these techniques has its advantages and disadvantages, selection of a specific method for CVR testing depends on availability, acquired experience in interpreting the study, required precision, and cost. Cerebral autoregulation may be impaired in patients with symptomatic or asymptomatic carotid stenosis or occlusion and is associated with a higher risk of stroke or transient ischemic attack (TIA) ipsilateral to the carotid artery disease. CONCLUSION: Assessment of CVR can help stratify patients based on their risk of stroke or TIA and select patients who may benefit from revascularization therapies. Cerebral vasoreactivity testing may be useful to evaluate cerebral autoregulation after revascularization procedures as a surrogate endpoint of vascular events related to hypoperfusion or hyperperfusion.
Authors: E Ascher; A Hingorani; N Markevich; R Schutzer; W R Yorkovich; S Kallakuri; B Tsemekhim Journal: Eur J Vasc Endovasc Surg Date: 2003-05 Impact factor: 7.069
Authors: H Yamauchi; H Fukuyama; Y Nagahama; H Nabatame; M Ueno; S Nishizawa; J Konishi; H Shio Journal: J Nucl Med Date: 1999-12 Impact factor: 10.057
Authors: Robert L Grubb; William J Powers; Colin P Derdeyn; Harold P Adams; William R Clarke Journal: Neurosurg Focus Date: 2003-03-15 Impact factor: 4.047
Authors: Andrei V Alexandrov; Vijay K Sharma; Annabelle Y Lao; Georgios Tsivgoulis; Marc D Malkoff; Anne W Alexandrov Journal: Stroke Date: 2007-10-04 Impact factor: 7.914
Authors: R L Grubb; C P Derdeyn; S M Fritsch; D A Carpenter; K D Yundt; T O Videen; E L Spitznagel; W J Powers Journal: JAMA Date: 1998 Sep 23-30 Impact factor: 56.272
Authors: Marvin S Medow; Mira L Kothari; Amanda M Goetz; Mary Breige O'Donnell-Smith; Courtney Terilli; Julian M Stewart Journal: Physiol Rep Date: 2017-05