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Leptomeningeal collateral activation indicates severely impaired cerebrovascular reserve capacity in patients with symptomatic unilateral carotid artery occlusion
Journal of Cerebral Blood Flow & Metabolism ( IF 6.3 ) Pub Date : 2021-06-10 , DOI: 10.1177/0271678x211024373
Martina Sebök 1, 2 , Christiaan Hendrik Bas van Niftrik 1, 2 , Niklas Lohaus 2, 3 , Giuseppe Esposito 1, 2 , Mohamad El Amki 2, 4 , Sebastian Winklhofer 2, 3 , Susanne Wegener 2, 4 , Luca Regli 1, 2 , Jorn Fierstra 1, 2
Affiliation  

For patients with symptomatic unilateral internal carotid artery (ICA) occlusion, impaired cerebrovascular reactivity (CVR) indicates increased stroke risk. Here, the role of collateral activation remains a matter of debate, whereas angio-anatomical collateral abundancy does not necessarily imply sufficient compensatory flow provided. We aimed to further elucidate the role of collateral activation in the presence of impaired CVR. From a prospective database, 62 patients with symptomatic unilateral ICA occlusion underwent blood oxygenation-level dependent (BOLD) fMRI CVR imaging and a transcranial Doppler (TCD) investigation for primary and secondary collateral activation. Descriptive statistic and multivariate analysis were used to evaluate the relationship between BOLD-CVR values and collateral activation. Patients with activated secondary collaterals exhibited more impaired BOLD-CVR values of the ipsilateral hemisphere (p = 0.02). Specifically, activation of leptomeningeal collaterals showed severely impaired ipsilateral hemisphere BOLD-CVR values when compared to activation of ophthalmic collaterals (0.05 ± 0.09 vs. 0.12 ± 0.04, p = 0.005). Moreover, the prediction analysis showed leptomeningeal collateral activation as a strong independent predictor for ipsilateral hemispheric BOLD-CVR. In our study, ipsilateral leptomeningeal collateral activation is the sole collateral pathway associated with severely impaired BOLD-CVR in patients with symptomatic unilateral ICA occlusion.



中文翻译:

软脑膜侧支激活表明有症状的单侧颈动脉闭塞患者的脑血管储备能力严重受损

对于有症状的单侧颈内动脉 (ICA) 闭塞的患者,脑血管反应性 (CVR) 受损表明卒中风险增加。在这里,侧支激活的作用仍然是一个有争议的问题,而血管解剖侧支丰富并不一定意味着提供了足够的代偿性血流。我们旨在进一步阐明侧支激活在 CVR 受损的情况下的作用。从前瞻性数据库中,62 名有症状的单侧 ICA 闭塞患者接受了血氧水平依赖 (BOLD) fMRI CVR 成像和经颅多普勒 (TCD) 初级和次级侧支激活调查。描述性统计和多变量分析用于评估 BOLD-CVR 值与侧枝激活之间的关系。次级侧支激活的患者同侧半球的 BOLD-CVR 值受损程度更高(p = 0.02)。具体而言,与眼部侧支的激活相比,软脑膜侧支的激活显示同侧半球 BOLD-CVR 值严重受损(0.05 ± 0.09 与 0.12 ± 0.04,p = 0.005)。此外,预测分析显示软脑膜侧支激活是同侧半球 BOLD-CVR 的一个强有力的独立预测因子。在我们的研究中,在有症状的单侧 ICA 闭塞患者中,同侧软脑膜侧支激活是与 BOLD-CVR 严重受损相关的唯一侧支通路。与眼部侧支激活相比,软脑膜侧支激活显示同侧半球 BOLD-CVR 值严重受损(0.05 ± 0.09 对 0.12 ± 0.04,p = 0.005)。此外,预测分析显示软脑膜侧支激活是同侧半球 BOLD-CVR 的一个强有力的独立预测因子。在我们的研究中,在有症状的单侧 ICA 闭塞患者中,同侧软脑膜侧支激活是与 BOLD-CVR 严重受损相关的唯一侧支通路。与眼部侧支激活相比,软脑膜侧支激活显示同侧半球 BOLD-CVR 值严重受损(0.05 ± 0.09 对 0.12 ± 0.04,p = 0.005)。此外,预测分析显示软脑膜侧支激活是同侧半球 BOLD-CVR 的一个强有力的独立预测因子。在我们的研究中,在有症状的单侧 ICA 闭塞患者中,同侧软脑膜侧支激活是与 BOLD-CVR 严重受损相关的唯一侧支通路。

更新日期:2021-06-11
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