Long-term changes in cerebral blood flow according to different types of ischemic stroke

Abstract Background Cerebrovascular reactivity (CVR) is the change in cerebral blood flow in response to a vaso-active stimulus, and may assist the treatment strategy of ischemic stroke. However, previous studies reported that a therapeutic strategy for stroke mainly depends on the degree of vascular stenosis with steady-state vascular parameters (e.g., cerebral blood flow and CVR). Hence, measurement of CVR by multimodal imaging techniques may improve the treatment of ischemic stroke. Methods/design This is a prospective, randomized, controlled clinical trial that aimed to examine the capability of multimodal imaging techniques for the evaluation of CVR to improve treatment of patients with ischemic stroke. A total of 66 eligible patients will be recruited from Renji Hospital, Shanghai Jiaotong University School of Medicine. The patients will be categorized based on CVR into two subgroups as follows: CVR > 10% group and CVR < 10% group. The patients will be randomly assigned to medical management, percutaneous transluminal angioplasty and stenting, and intracranial and extra-cranial bypass groups in a 1:1:1 ratio. The primary endpoint is all adverse events and ipsilateral stroke recurrence at 6, 12, and 24 months after management. The secondary outcomes include the CVR, the National Institute of Health stroke scale and the Modified Rankin Scale at 6, 12, and 24 months. Discussion Measurement of cerebrovascular reserve by multimodal image is recommended by most recent studies to guide the treatment of ischemic stroke, and thus its efficacy and evaluation accuracy need to be established in randomized controlled settings. This prospective, parallel, randomized, controlled registry study, together with other ongoing studies, should present more evidence for optimal individualized accurate treatment of ischemic stroke. Trial registration Chinese Clinical Trial Registry, ID: ChiCTR-IOR-16009635; Registered on 16 October 2016. All items are from the World Health Organization Trial Registration Data Set and registration in the Chinese Clinical Trial Registry: ChiCTR-IOR-16009635.

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Early microvascular cerebral blood flow response to head-of-bed elevation is related to outcome in acute ischemic stroke

Journal of Neurology ◽

10.1007/s00415-019-09226-y ◽

2019 ◽

Vol 266 (4) ◽

pp. 990-997 ◽

Cited By ~ 4

Author(s):

Clara Gregori-Pla ◽

Igor Blanco ◽

Pol Camps-Renom ◽

Peyman Zirak ◽

Isabel Serra ◽

...

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Ischemic Stroke ◽

Acute Ischemic Stroke ◽

Blood Flow Response ◽

Bed Elevation ◽

Flow Response ◽

Head Of Bed Elevation

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Comparative randomized study of cerebral blood flow after long-term administration of pentoxifylline and co-dergocrine mesylate in patients with chronic cerebrovascular disease

Current Medical Research and Opinion ◽

10.1185/03007998509109621 ◽

1985 ◽

Vol 9 (7) ◽

pp. 475-479 ◽

Cited By ~ 6

Author(s):

A. Hartmann

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Cerebrovascular Disease ◽

Randomized Study ◽

Term Administration

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Changes in cerebral blood flow and oxygen metabolism during moderate hypothermia in patients with severe middle cerebral artery infarction

Neurosurgical FOCUS ◽

10.3171/foc.2000.8.5.4 ◽

2000 ◽

Vol 8 (5) ◽

pp. 1-4 ◽

Cited By ~ 11

Author(s):

Emanuela Keller ◽

Thorsten Steiner ◽

Javier Fandino ◽

Stefan Schwab ◽

Werner Hacke

Keyword(s):

Blood Flow ◽

Cerebral Blood Flow ◽

Ischemic Stroke ◽

Middle Cerebral Artery ◽

Cerebral Artery ◽

Mild Hypothermia ◽

Indicator Dilution ◽

Dilution Method ◽

Moderate Hypothermia ◽

Double Indicator Dilution

Object Moderate hypothermia has been reported to be effective in the treatment of postischemic brain edema. The effect of hypothermia on cerebral hemodynamics is a matter of controversial discussion in literature. Clinical studies have yet to be performed in patients with ischemic stroke after induction of hypothermia. Methods Measurements during mild hypothermia (33–34°C) were made in six patients with severe ischemic stroke involving the middle cerebral artery territory. Hypothermia was induced as soon as possible and maintained for 48 to 72 hours. Cerebral blood flow (CBF) and cerebral metabolic rate of oxygen (CMRO2) were estimated by a new double-indicator dilution method. Measurements of CBF were made during normothermia, immediately after induction of hypothermia, at the end of hypothermia, and after rewarming. A total of 19 measurements of CBF and jugular bulb O2 saturation were made. Immediately after induction of hypothermia, CBF decreased in all patients. During late hypothermia, CBF improved in patients who survived but remained diminished in the two patients who died. Reduced CMRO2 levels were observed during all phases of hypothermia in all but one case. Conclusions Preliminary oberservations indicate that moderate hypothermia seems to reduce CMRO2 Immediately after induction of hypothermia, CBF may decrease in all patients. During late hypothermia CBF seems to recover in patients with good outcome but remains diminished in patients who die. Serial bedside CBF measurements with the new double-indicator dilution technique may be useful to describe cerebral hemodynamic characteristics in patients with severe ischemic stroke during hypothermia.

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