Unstable cerebral hemodynamics in carotid artery occlusion and large hemispheric stroke: a cerebral blood flow volume
Wolf-Dirk Niesen1, Cornelius Weiller, Ulrich Sliwka
1Department of Neurology, Universitätsklinikum Hamburg-Eppendorf, Martinistr.52, D-20246, Germany. niesen@uke.unihamburg.de
Insights
Cerebral blood flow volume (CBVF) measurement can identify patients with large hemispheric stroke in internal carotid artery (ICA) occlusion. Reduced CBVF indicates hemodynamic instability, crucial for early stroke prediction.
Area of Science:
- Neurology
- Vascular Medicine
- Diagnostic Imaging
Background:
- Cerebral hemodynamics are typically stable in chronic internal carotid artery (ICA) occlusion due to collateral circulation.
- Assessing hemodynamic stability is crucial for identifying patients at risk of stroke.
Purpose of the Study:
- To evaluate cerebral hemodynamics in ICA occlusion using cerebral blood flow volume (CBVF) measurement.
- To identify differences in CBVF that may predict large hemispheric stroke in ICA occlusion patients.
Main Methods:
- Utilized an ultrasound method to measure CBVF, summing flow from both internal carotid and vertebral arteries.
- Analyzed CBVF in 29 patients with ICA occlusion across four groups, including those with and without stroke.
- Employed receiver-operating characteristic analysis to determine a CBVF cutoff for large hemispheric stroke.
Main Results:
- Overall CBVF was lower in ICA occlusion patients compared to healthy volunteers, particularly in acute ICA occlusion and large hemispheric stroke groups.
- No significant CBVF differences were observed between chronic ICA occlusion without stroke, with minor stroke, and acute minor stroke groups.
- CBVF was significantly reduced in patients with ICA occlusion and large hemispheric stroke compared to all other groups, indicating hemodynamic instability. A CBVF cutoff achieved 100% sensitivity and 95.8% specificity for detecting large hemispheric stroke.
Conclusions:
- Acute ICA occlusion is linked to decreased CBVF compared to chronic ICA occlusion.
- ICA occlusion combined with large hemispheric stroke signifies unstable cerebral hemodynamics.
- CBVF measurement shows promise as a tool for early prediction of large middle cerebral artery strokes in ICA occlusion.
Purpose:
In chronic internal carotid artery (ICA) occlusion, cerebral hemodynamics are likely to be stable due to collateral flow. The authors evaluated cerebral hemodynamics in ICA occlusion using the sonographic method of cerebral blood flow volume (CBVF) measurement to find differences that might identify patients with large hemispheric stroke in ICA occlusion.
Method And Results:
The ultrasound method of CBVF measurement was used, which represents the sum of flow volumes of both internal carotid and both vertebal arteries. CBVF was measured in 29 patients with ICA occlusion including patients with (1) chronic ICA occlusion without acute minor stroke, (2) chronic ICA occlusion with acute minor stroke, (3) acute minor stroke due to acute ICA occlusion, and (4) ICA occlusion and large hemispheric stroke. In ICA occlusion, overall CBVF is lower compared to healthy volunteers, due to a significant reduction of CBVF in groups 3 and 4. Comparing groups, there were no differences in CBVF between groups 1, 2, and 3. CBVF in group 4 is reduced compared to all other groups. By receiver-operating characteristic analysis, a CBVF cutoff value for large hemispheric stroke was computed with a sensitivity of 100% and a specificity of 95.8%.
Conclusion:
Stroke due to acute ICA occlusion is associated with decreased CBVF compared to chronic ICA occlusion. Moreover, ICA occlusion and large hemispheric stroke are associated with decreased CBVF compared to all other groups, indicating instability of cerebral hemodynamics. CBVF measurement thus may be a useful tool in predicting large middle cerebral artery stroke early in ICA occlusion.
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