Mapping Cerebrovascular Reactivity Impairment in Patients With Symptomatic Unilateral Carotid Artery Disease

Autor: Susanne Wegener, Luca Regli, Sebastian Winklhofer, Christoph Stippich, Giuseppe Esposito, Jorn Fierstra, Andreas R. Luft, Christiaan Hendrik Bas van Niftrik, Martina Sebök
Přispěvatelé: University of Zurich, Sebök, Martina
Rok vydání: 2021
Předmět:
Male
Hemodynamics
030218 nuclear medicine & medical imaging
0302 clinical medicine
Carotid artery disease
Occlusion
Medicine
Carotid Stenosis
Prospective Studies
Prospective cohort study
Original Research
Middle Aged
Stroke
Cerebrovascular Circulation
Cohort
Functional Magnetic Resonance Imaging (fMRI)
Cardiology
Female
Internal carotid artery
Cardiology and Cardiovascular Medicine
Carotid Artery
Internal
Switzerland
Brain Infarction
medicine.medical_specialty
Perfusion Imaging
610 Medicine & health
2705 Cardiology and Cardiovascular Medicine
10180 Clinic for Neurosurgery
03 medical and health sciences
10043 Clinic for Neuroradiology
Predictive Value of Tests
hemodynamic
medicine.artery
Internal medicine
Humans
Aged
Ischemic Stroke
Clinical neuroscience
business.industry
ICA stenosis
ischemic infarct
Transient Ischemic Attack (TIA)
medicine.disease
10040 Clinic for Neurology
BOLD‐CVR
Stenosis
Diffusion Magnetic Resonance Imaging
Case-Control Studies
business
030217 neurology & neurosurgery
ICA occlusion
Zdroj: Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease
ISSN: 2047-9980
Popis: Background Comprehensive hemodynamic impairment mapping using blood oxygenation‐level dependent (BOLD) cerebrovascular reactivity (CVR) can be used to identify hemodynamically relevant symptomatic unilateral carotid artery disease. Methods and Results This prospective cohort study was conducted between February 2015 and July 2020 at the Clinical Neuroscience Center of the University Hospital Zurich, Zurich, Switzerland. One hundred two patients with newly diagnosed symptomatic unilateral internal carotid artery (ICA) occlusion or with 70% to 99% ICA stenosis were included. An age‐matched healthy cohort of 12 subjects underwent an identical BOLD functional magnetic resonance imaging examination. Using BOLD functional magnetic resonance imaging with a standardized CO 2 stimulus, CVR impairment was evaluated. Moreover, embolic versus hemodynamic ischemic patterns were evaluated on diffusion‐weighted imaging. Sixty‐seven patients had unilateral ICA occlusion and 35 patients unilateral 70% to 99% ICA stenosis. Patients with ICA occlusion exhibited lower whole‐brain and ipsilateral hemisphere mean BOLD‐CVR values as compared with healthy subjects (0.12±0.08 versus 0.19±0.04, P =0.004 and 0.09±0.09 versus 0.18±0.04, P P =0.01 and 0.09±0.09 versus 0.15±0.05, P =0.01); however, only 40 (58%) patients of the cohort showed significant BOLD‐CVR impairment. Conversely, there was no difference in mean BOLD‐CVR values between healthy patients and patients with ICA stenosis, although 5 (14%) patients with ICA stenosis showed a significant BOLD‐CVR impairment. No significant BOLD‐CVR difference was discernible between patients with hemodynamic ischemic infarcts versus those with embolic infarct distribution (0.11±0.08 versus 0.13±0.06, P =0.12). Conclusions Comprehensive BOLD‐CVR mapping allows for identification of hemodynamically relevant symptomatic unilateral carotid artery stenosis or occlusion.
Databáze: OpenAIRE
Externí odkaz: