scholarly journals Gravitational effects on intracranial pressure and blood flow regulation in young men: a potential shunting role for the external carotid artery

2020 ◽  
Vol 129 (4) ◽  
pp. 901-908
Author(s):  
Shigehiko Ogoh ◽  
Takuro Washio ◽  
Julian F. R. Paton ◽  
James P. Fisher ◽  
Lonnie G. Petersen
Keyword(s):  
Blood Flow ◽  
Intracranial Pressure ◽  
Carotid Artery ◽  
Young Men ◽  
Flow Regulation ◽  
External Carotid Artery ◽  
External Carotid ◽  
Cerebral Hyperperfusion ◽  
Arterial Blood ◽  
Blood Flow Regulation

We investigated whether gravity-induced changes in intracranial pressure influence cerebral blood flow regulation in young men. We recorded extra- and intracerebral blood flow during changes in posture, and data indicate that the external carotid artery may serve as an overflow pathway to prevent cerebral hyperperfusion during increases in cerebral arterial blood pressure.

Regional redistribution of blood flow in the external and internal carotid arteries during acute hypotension

2014 ◽  
Vol 306 (10) ◽  
pp. R747-R751 ◽  
Author(s):  
Shigehiko Ogoh ◽  
Romain Lericollais ◽  
Ai Hirasawa ◽  
Sadayoshi Sakai ◽  
Hervé Normand ◽  
...  
Keyword(s):  
Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid ◽  
Duplex Ultrasound ◽  
Flow Regulation ◽  
External Carotid ◽  
Peripheral Vasculature ◽  
Abrupt Decrease ◽  
Blood Flow Regulation ◽  
Acute Hypotension

The present study examined to what extent an acute bout of hypotension influences blood flow in the external carotid artery (ECA) and the corresponding implications for blood flow regulation in the internal carotid artery (ICA). Nine healthy male participants were subjected to an abrupt decrease in arterial pressure via the thigh-cuff inflation-deflation technique. Duplex ultrasound was employed to measure beat-to-beat ECA and ICA blood flow. Compared with the baseline normotensive control, acute hypotension resulted in a heterogeneous blood flow response. ICA blood flow initially decreased following cuff release and then returned quickly to baseline levels. In contrast, the reduction in ECA blood flow persisted for 30 s following cuff release. Thus, the contribution of common carotid artery blood flow to the ECA circulation decreased during acute hypotension (−10 ± 4%, P < 0.001). This finding suggests that a preserved reduction in ECA blood flow, as well as dynamic cerebral autoregulation likely prevent a further decrease in intracranial blood flow during acute hypotension. The peripheral vasculature of the ECA may, thus, be considered an important vascular bed for intracranial cerebral blood flow regulation.

Cerebral circulatory responses of near-term ovine fetuses during sustained fetal placental embolization

1997 ◽  
Vol 273 (4) ◽  
pp. H2001-H2008 ◽  
Author(s):  
Robert Gagnon ◽  
Tasha Lamb ◽  
Bryan Richardson
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Vascular Resistance ◽  
External Carotid Artery ◽  
External Carotid ◽  
Carotid Blood Flow ◽  
Arterial Blood ◽  
Pregnant Sheep ◽  
Flow Waveforms

To test the hypothesis that, in response to an increase in placental vascular resistance and progressive fetal asphyxia, the changes in external carotid blood flow waveforms are directly related to changes in external carotid vascular resistance, we embolized the fetal side of the placenta in pregnant sheep and measured cerebral and external carotid artery circulatory changes in relation to changes in external carotid artery flow waveforms. Chronically catheterized fetal sheep at 0.85 of gestation were embolized ( n = 11) in the descending aorta for 6 h, until fetal arterial pH fell to ∼6.90. Fetuses became rapidly hypoxemic ( P < 0.0001) and developed a mixed respiratory and metabolic acidosis ( P< 0.0001 for [Formula: see text], pH, and base excess). There was a transient 40% increase in external carotid blood flow at pH ∼7.25 and a parallel 32% increase in fetal arterial blood pressure (both P < 0.01), whereas the external vascular resistance remained unaltered. Cerebral blood flow increased by 130% ( P < 0.0001), and cerebral vascular resistance decreased by 125% ( P < 0.0001) throughout the study. The external carotid resistance index (RI) decreased by 32% ( P < 0.0001) at the time external carotid vascular resistance remained unchanged. This fall in external carotid RI was due almost entirely to a 110% increase in external carotid fundamental impedance ( P < 0.001). We conclude that the poor relationship between the changes in external carotid vascular resistance and RI indicated that other hemodynamic factors such as vascular impedance to pulsatile flow must be measured for correct interpretation of changes in flow waveform shape under hypoxic conditions. In addition, changes in external carotid blood flow were not proportional to changes in cerebral blood flow in this model.

Dynamic Computed Tomography Angiography in Suspected Brain Death: A Noninvasive Biomarker

2014 ◽  
Vol 65 (4) ◽  
pp. 352-359 ◽  
Author(s):  
Santanu Chakraborty ◽  
Reem A. Adas
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid Artery ◽  
Brain Death ◽  
Internal Carotid ◽  
External Carotid Artery ◽  
External Carotid ◽  
Ancillary Test ◽  
Organ Harvesting

Purpose Neurologic determination of death or brain death is primarily a clinical diagnosis. This must respect all guarantees required by law and should be determined early to avoid unnecessary treatment and allow organ harvesting for transplantation. Ancillary testing is used in situations in which clinical assessment is impossible or confounded by other factors. Our purpose is to determine the utility of dynamic computed tomographic angiography (dCTA) as an ancillary test for diagnosis of brain death. Materials and Methods We retrospectively reviewed 13 consecutive patients with suspected brain death in the intensive care unit who had dCTA. Contrast appearance timings recorded from the dCTA data were compared to findings from 15 controls selected from patients who presented with symptoms of acute stroke but showed no stroke in follow-up imaging. Results The dCTA allows us to reliably assess cerebral blood flow and to record time of individual cerebral vessels opacification. It also helps us to assess the intracranial flow qualitatively against the flow in extracranial vessels as a reference. We compared the time difference between enhancement of the external and internal carotid arteries and branches. In all patients who were brain dead, internal carotid artery enhancement was delayed, which occurred after external carotid artery branches were opacified. Conclusion In patients with suspected brain death, dCTA reliably demonstrated the lack of cerebral blood flow, with extracranial circulation as an internal reference. Our initial results suggest that inversion of time of contrast appearance between internal carotid artery and external carotid artery branches at the skull base could predict a lack of distal intracranial flow.

scholarly journals Blood Flow Distribution during Heat Stress: Cerebral and Systemic Blood Flow

2013 ◽  
Vol 33 (12) ◽  
pp. 1915-1920 ◽  
Author(s):  
Shigehiko Ogoh ◽  
Kohei Sato ◽  
Kazunobu Okazaki ◽  
Tadayoshi Miyamoto ◽  
Ai Hirasawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Heat Stress ◽  
Carotid Artery ◽  
Flow Distribution ◽  
Systemic Circulation ◽  
External Carotid Artery ◽  
Whole Body ◽  
External Carotid ◽  
Blood Flows ◽  
Induced Changes

The purpose of the present study was to assess the effect of heat stress-induced changes in systemic circulation on intra- and extracranial blood flows and its distribution. Twelve healthy subjects with a mean age of 22±2 (s.d.) years dressed in a tube-lined suit and rested in a supine position. Cardiac output (Q), internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA) blood flows were measured by ultrasonography before and during whole body heating. Esophageal temperature increased from 37.0±0.2°C to 38.4±0.2°C during whole body heating. Despite an increase in Q (59±31%, P<0.001), ICA and VA decreased to 83±15% ( P=0.001) and 87±8% ( P=0.002), respectively, whereas ECA blood flow gradually increased from 188±72 to 422±189 mL/minute (+135%, P<0.001). These findings indicate that heat stress modified the effect of Q on blood flows at each artery; the increased Q due to heat stress was redistributed to extracranial vascular beds.

Abstract TP446: Independent Measures of Cerebral Blood Flow in Asymptomatic Carotid Artery Disease.

Stroke ◽  
2016 ◽  
Vol 47 (suppl_1) ◽  
Author(s):  
Randolph S Marshall ◽  
MaryKay Pavol ◽  
Ken Cheung ◽  
Isabelle Strom ◽  
Kevin Slane ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Function Analysis ◽  
Flow Regulation ◽  
Critical Element ◽  
Mean Flow ◽  
Blood Flow Regulation ◽  
Hemodynamic State ◽  
Transfer Function Analysis

Background: Cerebral blood flow (CBF) regulation is a critical element in cerebrovascular pathophysiology, particularly in large vessel disease. Different methods to assess hemodynamics may represent different aspects of blood flow regulation, however, uniquely affecting outcomes and management. We examined 4 different blood-flow related measures in patients with high-grade unilateral carotid disease, assessing asymmetry between the occluded vs non-occluded side, and the correlations among the measures. Methods: Thirty-three patients (age 50-93, 19M) with unilateral 80-100% ICA occlusion but no stroke underwent: 1) quantitative resting CBF using continuous arterial spin labeling (CASL) MRI, 2) mean flow velocity (MFV) in both middle cerebral arteries (MCAs) by transcranial Doppler, 3). Vasomotor reactivity (VMR) in response to 2 minutes of 5% CO2 inhalation, and 4) Dynamic cerebral autoregulation (DCA) using continuous insonation of both MCAs for 10 minutes at depth 56mm with a standard head frame. Phase shift (PS) between spontaneous oscillations in blood pressure (measured with finger photoplethysmography) and MCA MFV at frequencies .06-.12 Hz was calculated for each hemisphere using transfer function analysis. Lower PS indicated worse autoregulation. Paired T-tests and Pearson correlations were used to look for side-to-side differences within each measure, and correlations between measures (SPSS v.22). Results: CASL CBF (p=.001), MFV (p<.001), VMR (p=.008), and DCA (p=.047) all showed significantly lower values on the occluded side. The 4 measures were independent of each other on correlation analysis, even when controlling for age and anterior circle of Willis collateral (correlation coefficients all <0.40, p-values >0.09). Conclusions: These 4 measures showed high sensitivity to the occluded carotid artery, but appear to represent independent aspects of cerebral blood flow (CASL: resting gray matter CBF; MFV: whole-hemisphere CBF; VMR: cerebrovascular reserve, and DCA: homeostatic blood flow regulation) suggesting that any given measure only partially characterizes hemodynamic state. Further investigation will use these 4 measures to predict outcomes including vascular cognitive impairment.

scholarly journals Effect of increases in cardiac contractility on cerebral blood flow in humans

2017 ◽  
Vol 313 (6) ◽  
pp. H1155-H1161 ◽  
Author(s):  
Shigehiko Ogoh ◽  
Gilbert Moralez ◽  
Takuro Washio ◽  
Satyam Sarma ◽  
Michinari Hieda ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cardiac Output ◽  
Cerebral Blood Flow ◽  
Carotid Artery ◽  
Internal Carotid ◽  
Cardiac Contractility ◽  
External Carotid Artery ◽  
External Carotid ◽  
High Dose ◽  
Artery Blood Flow

The effect of acute increases in cardiac contractility on cerebral blood flow (CBF) remains unknown. We hypothesized that the external carotid artery (ECA) downstream vasculature modifies the direct influence of acute increases in heart rate and cardiac function on CBF regulation. Twelve healthy subjects received two infusions of dobutamine [first a low dose (5 μg·kg−1·min−1) and then a high dose (15 μg·kg−1·min−1)] for 12 min each. Cardiac output, blood flow through the internal carotid artery (ICA) and ECA, and echocardiographic measurements were performed during dobutamine infusions. Despite increases in cardiac contractility, cardiac output, and arterial pressure with dobutamine, ICA blood flow and conductance slightly decreased from resting baseline during both low- and high-dose infusions. In contrast, ECA blood flow and conductance increased appreciably during both low- and high-dose infusions. Greater ECA vascular conductance and corresponding increases in blood flow may protect overperfusion of intracranial cerebral arteries during enhanced cardiac contractility and associated increases in cardiac output and perfusion pressure. Importantly, these findings suggest that the acute increase of blood perfusion attributable to dobutamine administration does not cause cerebral overperfusion or an associated risk of cerebral vascular damage. NEW & NOTEWORTHY A dobutamine-induced increase in cardiac contractility did not increase internal carotid artery blood flow despite an increase in cardiac output and arterial blood pressure. In contrast, external carotid artery blood flow and conductance increased. This external cerebral blood flow response may assist with protecting from overperfusion of intracranial blood flow.

Hyperthermia modulates regional differences in cerebral blood flow to changes in CO2

2014 ◽  
Vol 117 (1) ◽  
pp. 46-52 ◽  
Author(s):  
Shigehiko Ogoh ◽  
Kohei Sato ◽  
Kazunobu Okazaki ◽  
Tadayoshi Miyamoto ◽  
Ai Hirasawa ◽  
...  
Keyword(s):  
Blood Flow ◽  
Cerebral Blood Flow ◽  
Heat Stress ◽  
Carotid Artery ◽  
Thermal Conditions ◽  
External Carotid Artery ◽  
Whole Body ◽  
External Carotid ◽  
Left Middle Cerebral Artery ◽  
Blood Flows

The purpose of this study was to assess blood flow responses to changes in carbon dioxide (CO2) in the internal carotid artery (ICA), external carotid artery (ECA), and vertebral artery (VA) during normothermic and hyperthermic conditions. Eleven healthy subjects aged 22 ± 2 (SD) yr were exposed to passive whole body heating followed by spontaneous hypocapnic and hypercapnic challenges in normothermic and hyperthermic conditions. Right ICA, ECA, and VA blood flows, as well as left middle cerebral artery (MCA) mean blood velocity ( Vmean), were measured. Esophageal temperature was elevated by 1.53 ± 0.09°C before hypocapnic and hypercapnic challenges during heat stress. Whole body heating increased ECA blood flow and cardiac output by 130 ± 78 and 47 ± 26%, respectively ( P < 0.001), while blood flow (or velocity) in the ICA, MCA, and VA was reduced by 17 ± 14, 24 ± 18, and 12 ± 7%, respectively ( P < 0.001). Regardless of the thermal conditions, ICA and VA blood flows and MCA Vmean were decreased by hypocapnic challenges and increased by hypercapnic challenges. Similar responses in ECA blood flow were observed in hyperthermia but not in normothermia. Heat stress did not alter CO2 reactivity in the MCA and VA. However, CO2 reactivity in the ICA was decreased (3.04 ± 1.17 vs. 2.23 ± 1.03%/mmHg; P = 0.039) but that in the ECA was enhanced (0.45 ± 0.47 vs. 0.95 ± 0.61%/mmHg; P = 0.032). These results indicate that hyperthermia is capable of altering dynamic cerebral blood flow regulation.

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