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Evaluation of Cerebral Blood Flow Autoregulation in the Rat Using Laser Doppler Flowmetry
Published on: January 19, 2020
Perfusion-Dependent Cerebral Autoregulation Impairment in Hemispheric Stroke
Nils Hecht1,2, Max Schrammel1,2,3, Konrad Neumann4
1Department of Neurosurgery, Charité - Universitätsmedizin Berlin, corporate member of Freie Universität Berlin, Humboldt-Universität zu Berlin, and Berlin Institute of Health, Berlin, Germany.
Insights
Cerebral autoregulation (CA) is impaired across the entire hemisphere after stroke, especially in hypoperfused areas. Precise localization of these regions is crucial for tailoring treatment strategies to improve patient outcomes.
Area of Science:
- Neurology
- Neurosurgery
- Critical Care Medicine
Background:
- Loss of cerebral autoregulation (CA) contributes to secondary brain injury after acute cerebral injury.
- Current clinical assessments of CA are limited to specific brain compartments, leaving regional distribution unclear.
Purpose of the Study:
- To perform large-scale regional mapping of cortical perfusion and CA in patients undergoing decompressive surgery for malignant hemispheric stroke.
- To investigate the relationship between cerebral perfusion levels and the degree of CA impairment.
Main Methods:
- Intraoperative laser speckle imaging and mean arterial blood pressure (MAP) monitoring were used to measure cortical perfusion in 24 patients.
- Cortical perfusion was normalized to non-infarcted tissue, and CA was calculated using linear random slope models and Pearson correlation.
- Six perfusion categories were defined, ranging from 0% to over 100%.
Main Results:
- Cerebral autoregulation impairment was heterogeneously distributed across the hemisphere.
- Greater CA impairment was observed in critically hypoperfused areas (40-60% and 60-80% perfusion) compared to non-infarcted or infarcted regions.
- Pearson correlation confirmed significant CA impairment at critically reduced perfusion levels.
Conclusions:
- Cerebral autoregulation is impaired to varying degrees throughout the hemisphere following a stroke.
- Autoregulation impairment is most pronounced in hypoperfused, potentially viable brain tissue.
- Accurate localization of these compromised regions is essential for developing targeted, perfusion pressure-based treatment strategies.
Objective:
Loss of cerebral autoregulation (CA) plays a key role in secondary neurologic injury. However, the regional distribution of CA impairment after acute cerebral injury remains unclear because, in clinical practice, CA is only assessed within a limited compartment. Here, we performed large-scale regional mapping of cortical perfusion and CA in patients undergoing decompressive surgery for malignant hemispheric stroke.
Methods:
In 24 patients, autoregulation over the affected hemisphere was calculated based on direct, 15 to 20-minute cortical perfusion measurement with intraoperative laser speckle imaging and mean arterial blood pressure (MAP) recording. Cortical perfusion was normalized against noninfarcted tissue and 6 perfusion categories from 0% to >100% were defined. The interaction between cortical perfusion and MAP was estimated using a linear random slope model and Pearson correlation.
Results:
Cortical perfusion and CA impairment were heterogeneously distributed across the entire hemisphere. The degree of CA impairment was significantly greater in areas with critical hypoperfusion (40-60%: 0.42% per mmHg and 60-80%: 0.46% per mmHg) than in noninfarcted (> 100%: 0.22% per mmHg) or infarcted (0-20%: 0.29% per mmHg) areas (*p < 0.001). Pearson correlation confirmed greater CA impairment at critically reduced perfusion (20-40%: r = 0.67; 40-60%: r = 0.68; and 60-80%: r = 0.68) compared to perfusion > 100% (r = 0.36; *p < 0.05). Tissue integrity had no impact on the degree of CA impairment.
Interpretation:
In hemispheric stroke, CA is impaired across the entire hemisphere to a variable extent. Autoregulation impairment was greatest in hypoperfused and potentially viable tissue, suggesting that precise localization of such regions is essential for effective tailoring of perfusion pressure-based treatment strategies. ANN NEUROL 2021;89:358-368.
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