Arterial and Venous Cerebral Blood Flow Velocities and Their Correlation in Healthy Volunteers and Traumatic Brain Injury Patients.
Journal
Journal of neurosurgical anesthesiology
ISSN: 1537-1921
Titre abrégé: J Neurosurg Anesthesiol
Pays: United States
ID NLM: 8910749
Informations de publication
Date de publication:
01 Jan 2022
01 Jan 2022
Historique:
received:
12
12
2019
accepted:
13
05
2020
pubmed:
20
6
2020
medline:
15
12
2021
entrez:
20
6
2020
Statut:
ppublish
Résumé
Few studies have explored the cerebral venous compartment or the correlation between venous and arterial cerebral blood flows. We aimed to correlate cerebral blood flow velocities in the arterial (middle cerebral artery) and venous (straight sinus) compartments in healthy volunteers and traumatic brain injury (TBI) patients. In addition, we determined the normative range of these parameters. A total of 122 healthy volunteers and 95 severe TBI patients of both sexes were included and stratified into 3 age groups as follows: group 1 (aged, 18 to 44 y); group 2 (aged, 45 to 64 y); group 3 (older than 65 y). Transcranial Doppler systolic cerebral blood flow velocity, diastolic cerebral blood flow velocity, and mean cerebral blood flow velocity (FVs, FVd, FVm, respectively) were measured in the middle cerebral artery and peak cerebral venous blood flow velocity (FVVs) was measured in the straight sinus. The arteriovenous correlation was assessed on the basis of a positive relationship between FVs and FVVs. There was an arteriovenous correlation (FVs vs. FVVs) in healthy volunteers (R=0.39, P<0.0001). We found no arteriovenous correlation in the TBI cohort overall, but FVs and FVVs were correlated in age group 1 (R=0.28, P=0.05) and in males (R=0.29, P=0.01). In healthy volunteers, FVs and FVm were significantly higher in males compared with females; and FVs, FVm, FVd, FVVs all increased across the age spectrum. There were no significant differences in any of these parameters in TBI patients. There are age and sex differences in arterial and venous cerebral blood flow velocities in healthy volunteers. Arteriovenous correlation is present in healthy volunteers but absent in TBI patients.
Sections du résumé
BACKGROUND
BACKGROUND
Few studies have explored the cerebral venous compartment or the correlation between venous and arterial cerebral blood flows. We aimed to correlate cerebral blood flow velocities in the arterial (middle cerebral artery) and venous (straight sinus) compartments in healthy volunteers and traumatic brain injury (TBI) patients. In addition, we determined the normative range of these parameters.
MATERIALS AND METHODS
METHODS
A total of 122 healthy volunteers and 95 severe TBI patients of both sexes were included and stratified into 3 age groups as follows: group 1 (aged, 18 to 44 y); group 2 (aged, 45 to 64 y); group 3 (older than 65 y). Transcranial Doppler systolic cerebral blood flow velocity, diastolic cerebral blood flow velocity, and mean cerebral blood flow velocity (FVs, FVd, FVm, respectively) were measured in the middle cerebral artery and peak cerebral venous blood flow velocity (FVVs) was measured in the straight sinus. The arteriovenous correlation was assessed on the basis of a positive relationship between FVs and FVVs.
RESULTS
RESULTS
There was an arteriovenous correlation (FVs vs. FVVs) in healthy volunteers (R=0.39, P<0.0001). We found no arteriovenous correlation in the TBI cohort overall, but FVs and FVVs were correlated in age group 1 (R=0.28, P=0.05) and in males (R=0.29, P=0.01). In healthy volunteers, FVs and FVm were significantly higher in males compared with females; and FVs, FVm, FVd, FVVs all increased across the age spectrum. There were no significant differences in any of these parameters in TBI patients.
CONCLUSIONS
CONCLUSIONS
There are age and sex differences in arterial and venous cerebral blood flow velocities in healthy volunteers. Arteriovenous correlation is present in healthy volunteers but absent in TBI patients.
Identifiants
pubmed: 32555064
pii: 00008506-202201000-00013
doi: 10.1097/ANA.0000000000000704
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
e24-e33Informations de copyright
Copyright © 2020 Wolters Kluwer Health, Inc. All rights reserved.
Déclaration de conflit d'intérêts
The authors have no conflicts of interest to disclose
Références
Robba C, Cardim D, Tajsic T, et al. Ultrasound non-invasive measurement of intracranial pressure in neurointensive care: a prospective observational study. PLoS Med. 2017;14:e1002356.
Robba C, Cardim D, Sekhon M, et al. Transcranial Doppler: a stethoscope for the brain-neurocritical care use. J Neurosci Res. 2018;96:720–730.
Zweifel C, Czosnyka M, Carrera E, et al. Reliability of the blood flow velocity pulsatility index for assessment of intracranial and cerebral perfusion pressures in head-injured patients. Neurosurgery. 2012;71:853–861.
Robba C, Goffi A, Geeraerts T, et al. Brain ultrasonography: methodology, basic and advanced principles and clinical applications. A narrative review. Intensive Care Med. 2019;45:913–927.
Valdueza JM, Schultz M, Harms L, et al. Venous transcranial Doppler ultrasound monitoring in acute dural sinus thrombosis. Report of two cases. Stroke. 1995;26:1196–1199.
Schoser BGH, Riemenschneider N, Hansen HC. The impact of raised intracranial pressure on cerebral venous hemodynamics: a prospective venous transcranial Doppler ultrasonography study. J Neurosurg. 1999;91:744–749.
Sarkar S, Ghosh S, Ghosh SK, et al. Role of transcranial Doppler ultrasonography in stroke. Postgrad Med J. 2007;83:683–689.
Ziegler D, Cravens G, Poche G, et al. Use of transcranial Doppler in patients with severe traumatic brain injuries. J Neurotrauma. 2017;34:121–127.
Baumgartner RW, Nirkko AC, Müri RM, et al. Transoccipital power-based color-coded duplex sonography of cerebral sinuses and veins. Stroke. 1997;28:1319–1323.
Becker G, Bogdahn U, Gehlberg C, et al. Transcranial color-coded real-time sonography of intracranial veins. J Neuroimaging. 1995;5:87–94.
Vriens EM, Kraaier V, Musbach M, et al. Transcranial pulsed Doppler measurements of blood velocity in the middle cerebral artery: reference values at rest and during hyperventilation in healthy volunteers in relation to age and sex. Ultrasound Med Biol. 1989;15:1–8.
Grolimund P, Seiler RW. Age dependence of the flow velocity in the basal cerebral arteries—a transcranial Doppler ultrasound study. Ultrasound Med Biol. 1988;14:191–198.
Tegeler CH, Crutchfield K, Katsnelson M, et al. Transcranial Doppler velocities in a large, healthy population. J Neuroimaging. 2013;23:466–472.
Krejza J, Mariak Z, Walecki J, et al. Transcranial color Doppler sonography of basal cerebral arteries in 182 healthy subjects: age and sex variability and normal reference values for blood flow parameters. AJR Am J Roentgenol. 1999;172:213–218.
von Elm E, Altman DG, Egger M, et al. The strengthening the reporting of observational studies in epidemiology (STROBE) statement: guidelines for reporting observational studies. Int J Surg. 2014;18:800–804.
Moretti R, Pizzi B. Ultrasonography of the optic nerve in neurocritically ill patients. Acta Anaesthesiol Scand. 2011;55:644–652.
Xing C-Y, Tarumi T, Meijers RL, et al. Arterial pressure, heart rate, and cerebral hemodynamics across the adult life span. Hypertension. 2017;69:712–720.
Patel N, Panerai RB, Haunton V, et al. The Leicester cerebral haemodynamics database: normative values and the influence of age and sex. Physiol Meas. 2016;37:1485–1498.
Tomoto T, Riley J, Turner M, et al. Cerebral vasomotor reactivity during hypo- and hypercapnia across the adult lifespan. J Cereb Blood Flow Metab. 2019;119:600–610.
Jefferson AL, Cambronero FE, Liu D, et al. Higher aortic stiffness is related to lower cerebral blood flow and preserved cerebrovascular reactivity in older adults. Circulation. 2018;138:1951–1962.
Zhu Y-S, Tseng BY, Shibata S, et al. Increases in cerebrovascular impedance in older adults. J Appl Physiol. 2011;111:376–381.
DuBose LE, Boles Ponto LL, Moser DJ, et al. Higher aortic stiffness is associated with lower global cerebrovascular reserve among older humans. Hypertension. 2018;72:476–482.
Teixeira SC, Madureira JB, Azevedo EI, et al. Ageing affects the balance between central and peripheral mechanisms of cerebrovascular regulation with increasing influence of systolic blood pressure levels. Eur J Appl Physiol. 2019;119:519–529.
Menon DK. Cerebral protection in severe brain injury: physiological determinants of outcome and their optimisation. Br Med Bull. 1999;55:226–258.
Matteis M, Troisi E, Monaldo BC, et al. Age and sex differences in cerebral hemodynamics. Stroke. 1998;29:963–967.
Hart EC, Joyner MJ, Wallin BG, et al. Sex, ageing and resting blood pressure: gaining insights from the integrated balance of neural and haemodynamic factors. J Physiol. 2012;590:2069–2079.
Favre ME, Serrador JM. Sex differences in cerebral autoregulation is unaffected by menstrual cycle phase in young, healthy women. Am J Physiol Circ Physiol. 2019;316:H920–H933.
Famaey N, Ying Cui Z, Umuhire Musigazi G, et al. Structural and mechanical characterisation of bridging veins: a review. Available at: https://core.ac.uk/download/pdf/34606025.pdf . Accessed March 14, 2019.
Wilson MH. Monro-Kellie 2.0: the dynamic vascular and venous pathophysiological components of intracranial pressure. J Cereb Blood Flow Metab. 2016;36:1338–1350.
Wardlaw JM, Vaughan GT, Steers AJW, et al. Transcranial Doppler ultrasound findings in cerebral venous sinus thrombosis. J Neurosurg. 1994;80:332–335.
Miller JD, Stanek A, Langfitt TW. Concepts of cerebral perfusion pressure and vascular compression during intracranial hypertension. Prog Brain Res. 1972;35:411–432.
Dunn LT. Raised intracranial pressure. J Neurol Neurosurg Psychiatry. 2002;73(suppl 1):i23–i27.
Czosnyka M, Pickard JD. Monitoring and interpretation of intracranial pressure. J Neurol Neurosurg Psychiatry. 2004;75:813–821.
Sekhon MS, Griesdale DE, Ainslie PN, et al. Intracranial pressure and compliance in hypoxic ischemic brain injury patients after cardiac arrest. Resuscitation. 2019;141:96–103.
Scalea TM, Bochicchio GV, Habashi N, et al. Increased intra-abdominal, intrathoracic, and intracranial pressure after severe brain injury: multiple compartment syndrome. J Trauma Inj Infect Crit Care. 2007;62:647–656.
Citerio G, Vascotto E, Villa F, et al. Induced abdominal compartment syndrome increases intracranial pressure in neurotrauma patients: a prospective study. Crit Care Med. 2001;29:1466–1471.
Canhão P, Batista P, Ferro JM. Venous transcranial Doppler in acute dural sinus thrombosis. J Neurol. 1998;245:276–279.
Aaslid R, Newell DW, Stooss R, et al. Assessment of cerebral autoregulation dynamics from simultaneous arterial and venous transcranial Doppler recordings in humans. Stroke. 1991;22:1148–1154.
Brouwers PJ, Vriens EM, Musbach M, et al. Transcranial pulsed Doppler measurements of blood flow velocity in the middle cerebral artery: reference values at rest and during hyperventilation in healthy children and adolescents in relation to age and sex. Ultrasound Med Biol. 1990;16:1–8.