Impaired cerebrovascular reactivity is associated with recurrent stroke in patients with severe intracranial arterial stenosis: A C02 BOLD fMRI study.
J Neuroradiol
; 48(5): 339-345, 2021 Sep.
Article
em En
| MEDLINE
| ID: mdl-32466863
ABSTRACT
BACKGROUND AND PURPOSE:
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 ANDMETHODS:
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:
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:
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.Palavras-chave
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Base de dados:
MEDLINE
Assunto principal:
Imageamento por Ressonância Magnética
/
Circulação Cerebrovascular
Tipo de estudo:
Risk_factors_studies
Limite:
Humans
Idioma:
En
Revista:
J Neuroradiol
Ano de publicação:
2021
Tipo de documento:
Article
País de afiliação:
França