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Cerebrovascular reactivity and subcortical infarctions
L M Cupini1, M Diomedi, F Placidi
1Clinica Neurologica, Universita' di Roma "Tor Vergata," Ospedale S Eugenio, P. le Umanesimo 10, 00144 Rome, Italy. lecupini@tin.it
Insights
Patients with multiple subcortical infarctions show impaired cerebrovascular reactivity (CR). This finding highlights the role of small vessel disease and hypoperfusion in stroke pathogenesis.
Area of Science:
- Neurology
- Vascular Medicine
- Neuroimaging
Background:
- Cerebrovascular reactivity (CR) is crucial for maintaining brain blood flow.
- Ischemic stroke is a leading cause of disability and mortality worldwide.
- Understanding lesion types and their impact on CR is vital for stroke management.
Purpose of the Study:
- To investigate the association between different ischemic lesion types and cerebrovascular reactivity (CR).
- To evaluate the relationship between lesion types, CR, and major stroke risk factors.
Main Methods:
- CR was assessed using the breath-holding index (BHI) technique.
- Transcranial Doppler monitoring of middle cerebral arteries was performed.
- Patients with first-ever ischemic stroke were categorized by lesion type: cortical, single subcortical, and multiple subcortical infarctions.
Main Results:
- The BHI was significantly lower in patients with multiple subcortical infarctions compared to controls, single subcortical, and cortical infarction groups.
- Male sex and a history of hypertension correlated with low CR across all groups.
- Lesion type was the only significant factor influencing the BHI.
Conclusions:
- First-ever stroke patients with symptomatic subcortical infarction and multiple silent infarctions exhibit impaired cerebrovascular reserve capacity.
- The strong association suggests small vessel vasculopathy and hypoperfusion as key pathogenetic mechanisms.
- These findings underscore the importance of CR assessment in stroke patients with specific lesion patterns.
Objectives:
To investigate the association between different kinds of ischemic lesions and cerebrovascular reactivity (CR) and to evaluate their relationships with the major risk factors for stroke.
Subjects And Methods:
We evaluated CR using the breath-holding index technique during bilateral transcranial Doppler monitoring of flow velocity in the middle cerebral arteries of 41 consecutive patients attending our clinic for a recent, first-ever, ischemic stroke and in 15 control subjects. Based on the location of the lesion determined by computed tomography, the following 3 types of infarctions were identified: cortical (or territorial), single subcortical, and subcortical with multiple silent subcortical infarctions. Patients with a condition of severe carotid artery stenosis or occlusion, which in itself could account for altered CR, were excluded from this study. All physiological and pathologic conditions that could possibly cause an impairment in CR were recorded.
Results:
The breath-holding index was significantly lower in the multiple subcortical infarctions group than in the control subjects (P < .001), single subcortical infarctions group (P < .01), and cortical infarctions group (P < .01). In all of the groups male sex (P < .05) and a history of hypertension (P < .05), regardless of whether hypertension was treated, correlated with low CR. The multiple regression analysis indicated that the only significant factor able to influence the breath-holding index was the type of lesion.
Conclusions:
Nonstenotic patients with first-ever stroke who had a recent symptomatic subcortical infarction associated with multiple silent infarctions seem to have an impaired cerebrovascular reserve capacity. The strong association of subcortical infarctions with multiple silent infarctions with low CR indicates the role of small vessel vasculopathy and hypoperfusion as possible pathogenetic mechanisms of subcortical infarctions with multiple silent infarctions.