Pervinder Bhogal1, Leonard Leong Yeo2, Lucas O Müller3, Pablo J Blanco3,4. 1. Department of Interventional Neuroradiology, The Royal London Hospital, London, United Kingdom. 2. Division of Neurology, Department of Medicine, National University Health System, Singapore, Singapore. 3. National Laboratory for Scientific Computing, LNCC/MCTIC, Petrópolis, Brazil. 4. National Institute in Medicine Assisted by Scientific Computing, INCT-MACC, Petrópolis, Brazil.
Abstract
BACKGROUND: Induced hypertension has been used to promote cerebral blood flow under vasospastic conditions although there is no randomised clinical trial to support its use. We sought to mathematically model the effects of vasospasm on the cerebral blood flow and the effects of induced hypertension. METHODS: The Anatomically Detailed Arterial Network (ADAN) model is employed as the anatomical substrate in which the cerebral blood flow is simulated as part of the simulation of the whole body arterial circulation. The pressure drop across the spastic vessel is modelled by inserting a specific constriction model within the corresponding vessel in the ADAN model. We altered the degree of vasospasm, the length of the vasospastic segment, the location of the vasospasm, the pressure (baseline mean arterial pressure [MAP] 90 mm Hg, hypertension MAP 120 mm Hg, hypotension), and the presence of collateral supply. RESULTS: Larger decreases in cerebral flow were seen for diffuse spasm and more severe vasospasm. The presence of collateral supply could maintain cerebral blood flow, but only if the vasospasm did not occur distal to the collateral. Induced hypertension caused an increase in blood flow in all scenarios, but did not normalise blood flow even in the presence of moderate vasospasm (30%). Hypertension in the presence of a complete circle of Willis had a marginally greater effect on the blood flow, but did not normalise flow. CONCLUSION: Under vasospastic condition, cerebral blood flow varies considerably. Hypertension can raise the blood flow, but it is unable to restore cerebral blood flow to baseline.
BACKGROUND: Induced hypertension has been used to promote cerebral blood flow under vasospastic conditions although there is no randomised clinical trial to support its use. We sought to mathematically model the effects of vasospasm on the cerebral blood flow and the effects of induced hypertension. METHODS: The Anatomically Detailed Arterial Network (ADAN) model is employed as the anatomical substrate in which the cerebral blood flow is simulated as part of the simulation of the whole body arterial circulation. The pressure drop across the spastic vessel is modelled by inserting a specific constriction model within the corresponding vessel in the ADAN model. We altered the degree of vasospasm, the length of the vasospastic segment, the location of the vasospasm, the pressure (baseline mean arterial pressure [MAP] 90 mm Hg, hypertension MAP 120 mm Hg, hypotension), and the presence of collateral supply. RESULTS: Larger decreases in cerebral flow were seen for diffuse spasm and more severe vasospasm. The presence of collateral supply could maintain cerebral blood flow, but only if the vasospasm did not occur distal to the collateral. Induced hypertension caused an increase in blood flow in all scenarios, but did not normalise blood flow even in the presence of moderate vasospasm (30%). Hypertension in the presence of a complete circle of Willis had a marginally greater effect on the blood flow, but did not normalise flow. CONCLUSION: Under vasospastic condition, cerebral blood flow varies considerably. Hypertension can raise the blood flow, but it is unable to restore cerebral blood flow to baseline.
Authors: Celine S Gathier; Jan Willem Dankbaar; Mathieu van der Jagt; Bon H Verweij; Annemarie W Oldenbeuving; Gabriel J E Rinkel; Walter M van den Bergh; Arjen J C Slooter Journal: Stroke Date: 2015-10-06 Impact factor: 7.914
Authors: Ali Khanafer; Pervinder Bhogal; Victoria Hellstern; Christoph Harmening; Hansjörg Bäzner; Oliver Ganslandt; Hans Henkes Journal: J Clin Med Date: 2022-08-09 Impact factor: 4.964