Dynamic Cerebral Autoregulation in Embolic Stroke of Undetermined Source

Area of Science:

• Neurology
• Cerebrovascular Medicine
• Stroke Research

Background:

• Dynamic cerebral autoregulation (dCA) is crucial for maintaining stable cerebral blood flow.
• dCA is known to be compromised in various acute ischemic stroke types.
• dCA characteristics and prognostic value in embolic stroke of undetermined source (ESUS) are not well understood.

Purpose of the Study:

• To investigate the characteristics of dCA in patients with ESUS.
• To determine the relationship between dCA parameters and clinical outcomes in ESUS.

Main Methods:

• Seventy-seven ESUS patients and 50 controls underwent simultaneous bilateral middle cerebral artery blood flow velocity and arterial blood pressure monitoring.
• Transfer function analysis was employed to assess dCA parameters (phase, gain, coherence, rate of recovery - RoRc).
• Multivariable logistic regression analyzed the association between dCA and clinical outcomes.

Main Results:

• ESUS patients exhibited significantly impaired dCA (worse gain and phase at VLF/LF, and RoRc) compared to controls.
• Higher bilateral RoRc of cerebral blood flow velocity (CBFV) correlated with favorable clinical outcomes.
• RoRc of CBFV in the stroke hemisphere exceeding 13.3%/s independently predicted favorable outcomes (aOR=30.95).

Conclusions:

• Dynamic cerebral autoregulation is impaired in both hemispheres of ESUS patients.
• Effective dCA function post-ESUS is associated with better clinical prognoses.
• dCA assessment may aid in predicting recovery in ESUS patients.