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Brain Stress Test for Assessing Risk for Hemodynamic Stroke.

Lashmi Venkatraghavan1, Casey Rosen2, Larissa McKetton2

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Impaired cerebrovascular reactivity (CVR) in patients with intracranial steno-occlusive disease (SOD) indicates a higher stroke risk. Normal CVR suggests a low stroke risk, even with significant stenosis, validating CO2-BOLD MRI for assessment.

Keywords:
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Area of Science:

  • Neurology
  • Radiology
  • Vascular Medicine

Background:

  • Intracranial steno-occlusive disease (SOD) poses a stroke risk influenced by poststenotic vasodilatory reserve.
  • Cerebrovascular reactivity (CVR) quantifies this reserve, crucial for assessing hemodynamic stroke risk.
  • Assessing CVR using PETCO2 stress and Blood Oxygen Level Dependent (BOLD) MRI is vital for managing SOD patients.

Purpose of the Study:

  • To correlate cerebrovascular reactivity (CVR) measurements with the incidence of stroke in patients with symptomatic intracranial steno-occlusive disease (SOD).
  • To evaluate the utility of CO2-BOLD MRI CVR as a brain stress test for assessing cerebrovascular reserve.
  • To determine if normal CVR in the presence of significant stenosis is associated with a low stroke risk.

Main Methods:

  • Retrospective analysis of 100 consecutive patients with symptomatic intracranial SOD who underwent CVR testing.
  • CVR measured as % BOLD MR signal intensity change per mmHg PETCO2 increase.
  • One-year follow-up to determine stroke incidence, with treatment guided by CVR results (optimal medical therapy or revascularization).

Main Results:

  • 83 patients were included; 14 had normal CVR, and 69 had impaired CVR ipsilateral to the lesion.
  • Overall stroke incidence was 4.8% (4/83), exclusively in patients with impaired CVR (4/69).
  • No strokes occurred in patients with normal CVR (0/14); 86% of revascularized patients showed improved CVR and symptoms.

Conclusions:

  • CO2-BOLD MRI CVR effectively serves as a brain stress test for assessing cerebrovascular reserve.
  • Impaired CVR is significantly associated with an increased incidence of stroke in intracranial SOD patients.
  • Normal CVR, even with significant stenosis, indicates a low stroke risk, supporting its prognostic value.