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

Clara Gregori-Pla, Rickson C. Mesquita, Christopher G. Favilla, David R. Busch, Igor Blanco, Peyman Zirak, Lisa Kobayashi Frisk, Stella Avtzi, Federica Maruccia, Giacomo Giacalone, Gianluca Cotta, Pol Camps-Renom, Michael T. Mullen, Joan Martí-Fàbregas, Luís Prats-Sánchez, Alejandro Martínez-Domeño, Scott E. Kasner, Joel H. Greenberg, Chao Zhou, Brian L. EdlowMary E. Putt, John A. Detre, Arjun G. Yodh, Turgut Durduran, Raquel Delgado-Mederos

Research output: Contribution to journalArticlepeer-review

Abstract

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 ΔCBF 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.

Original languageEnglish (US)
Article number154
JournalBMC Neurology
Volume21
Issue number1
DOIs
StatePublished - Dec 2021

Keywords

  • Cerebral autoregulation
  • Cerebral blood flow
  • Cerebrovascular disease
  • Diffuse correlation spectroscopy
  • Diffuse optics
  • Mean arterial pressure

ASJC Scopus subject areas

  • Clinical Neurology

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