Impaired cerebrovascular reactivity is associated with recurrent stroke in patients with severe intracranial arterial stenosis: A C02 BOLD fMRI study.
BOLD fMRI
Cerebral vascular reactivity
Cerebral vascular reserve
Hypercapnia
Intracranial arterial stenosis
Stroke
Journal
Journal of neuroradiology = Journal de neuroradiologie
ISSN: 0150-9861
Titre abrégé: J Neuroradiol
Pays: France
ID NLM: 7705086
Informations de publication
Date de publication:
Sep 2021
Sep 2021
Historique:
received:
06
03
2020
revised:
08
04
2020
accepted:
28
04
2020
pubmed:
30
5
2020
medline:
26
11
2021
entrez:
30
5
2020
Statut:
ppublish
Résumé
Severe intracranial atherosclerotic stenosis (SIAS) remains at risk of recurrent ischemic events despite intensive medical management. Exhausted cerebrovascular reserve seems to be associated with higher risk of recurrent stroke. We used whole brain MRI to estimate basal perfusion using dynamic susceptibility contrast and cerebrovascular reactivity (CVR) to hypercapnic challenge (CO2 inhalation) using BOLD contrast, in 20 patients with symptomatic SIAS (>70%) of the middle cerebral artery (MCA) or the distal internal carotid artery. We studied relationships between individual clinical, biological, radiological baseline characteristics, recurrent ischemic events, basal perfusion parameters (mean transit time, delay, time to peak, cerebral blood flow and volume), and CVR measured in MCA territories (CVRMCA), and reported using laterality indices (LI). Ten patients had an impaired CVR with (|LI| CVRMCA≥0.08). During a mean follow-up of 3.3 years, all recurrent ipsilateral ischemic events occurred within the first year. They were more frequent in impaired CVRMCA group (n=7/10 patients) than in normal CVRMCA group (n=1/10), with different survival curves (log rank, P=0.007). Impaired CVR is associated with an increased rate of recurrent stroke in patients with symptomatic SIAS. CVR mapping should be used as a well tolerated method to select higher-risk patients in further therapeutic trials such as endovascular procedures.
Sections du résumé
BACKGROUND AND PURPOSE
OBJECTIVE
Severe intracranial atherosclerotic stenosis (SIAS) remains at risk of recurrent ischemic events despite intensive medical management. Exhausted cerebrovascular reserve seems to be associated with higher risk of recurrent stroke.
MATERIALS AND METHODS
METHODS
We used whole brain MRI to estimate basal perfusion using dynamic susceptibility contrast and cerebrovascular reactivity (CVR) to hypercapnic challenge (CO2 inhalation) using BOLD contrast, in 20 patients with symptomatic SIAS (>70%) of the middle cerebral artery (MCA) or the distal internal carotid artery. We studied relationships between individual clinical, biological, radiological baseline characteristics, recurrent ischemic events, basal perfusion parameters (mean transit time, delay, time to peak, cerebral blood flow and volume), and CVR measured in MCA territories (CVRMCA), and reported using laterality indices (LI).
RESULTS
RESULTS
Ten patients had an impaired CVR with (|LI| CVRMCA≥0.08). During a mean follow-up of 3.3 years, all recurrent ipsilateral ischemic events occurred within the first year. They were more frequent in impaired CVRMCA group (n=7/10 patients) than in normal CVRMCA group (n=1/10), with different survival curves (log rank, P=0.007).
CONCLUSION
CONCLUSIONS
Impaired CVR is associated with an increased rate of recurrent stroke in patients with symptomatic SIAS. CVR mapping should be used as a well tolerated method to select higher-risk patients in further therapeutic trials such as endovascular procedures.
Identifiants
pubmed: 32466863
pii: S0150-9861(20)30165-6
doi: 10.1016/j.neurad.2020.04.005
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
339-345Informations de copyright
Copyright © 2020. Published by Elsevier Masson SAS.