Characteristics of dynamic cerebral autoregulation in cerebral small vessel disease: Diffuse and sustained

Area of Science:

• Neurology
• Vascular Biology
• Cerebrovascular Disease

Background:

• Cerebral small vessel disease (CSVD) is a primary contributor to stroke and vascular dementia.
• The underlying pathogenesis of CSVD remains incompletely understood.
• Lacunar infarction represents the most common manifestation of CSVD.

Purpose of the Study:

• To investigate the characteristics of dynamic cerebral autoregulation (dCA) impairment in patients with lacunar infarction.
• To determine if dCA impairments are localized or global in unilateral stroke territories.
• To assess the temporal stability of dCA impairments over a 6-month follow-up period.

Main Methods:

• Seventy-one patients with lacunar infarction were enrolled, categorized by stroke territory (MCA or PCA).
• Patients underwent dCA assessments using transfer function analysis in bilateral MCA and PCA territories.
• Autoregulatory parameters, including gain and phase difference, were analyzed.

Main Results:

• Impairments in dCA were observed globally, affecting both ipsilateral and contralateral cerebral arteries (MCAs and PCAs) in patients with unilateral MCA or PCA territory strokes.
• These dCA impairments were found to be persistent and did not change significantly over the 6-month follow-up period.
• The findings were consistent across both MCA and PCA stroke patient groups.

Conclusions:

• Dynamic cerebral autoregulation impairment in lacunar infarction is a global phenomenon, not confined to the stroke-affected hemisphere.
• The observed global and sustained dCA impairments suggest diffuse underlying physiological changes associated with lacunar infarction.
• These findings highlight the widespread impact of lacunar infarction on cerebral hemodynamics and autoregulation.