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Brain Stress Test for Assessing Risk for Hemodynamic Stroke.
Venkatraghavan, Lashmi; Rosen, Casey; McKetton, Larissa; Poublanc, Julien; Sobczyk, Olivia; Duffin, James; Tymianski, Michael; Fisher, Joseph A; Mikulis, David J.
Afiliación
  • Venkatraghavan L; Department of Anaesthesia, University Health Network, Toronto, ON, Canada.
  • Rosen C; Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
  • McKetton L; Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
  • Poublanc J; Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
  • Sobczyk O; Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
  • Duffin J; Department of Physiology, The University of Toronto, Toronto, ON, Canada.
  • Tymianski M; Division of Neurosurgery, University Health Network, University of Toronto, Toronto, ON, Canada.
  • Fisher JA; Department of Anaesthesia, University Health Network, Toronto, ON, Canada.
  • Mikulis DJ; Division of Neuroradiology, Joint Department of Medical Imaging, University Health Network, Toronto, ON, Canada.
Can J Neurol Sci ; 51(1): 57-63, 2024 Jan.
Article en En | MEDLINE | ID: mdl-36624923
BACKGROUND: In patients with intracranial steno-occlusive disease (SOD), the risk of hemodynamic stroke depends on the poststenotic vasodilatory reserve. Cerebrovascular reactivity (CVR) is a test for vasodilatory reserve. We tested for vasodilatory reserve by using PETCO2 as the stressor, and Blood Oxygen Level Dependent (BOLD) MRI as a surrogate of blood flow. We correlate the CVR to the incidence of stroke after a 1-year follow-up in patients with symptomatic intracranial SOD. METHODS: In this retrospective study, 100 consecutive patients with symptomatic intracranial SOD that had undergone CVR testing were identified. CVR was measured as % BOLD MR signal intensity/mmHg PETCO2. All patients with normal CVR were treated with optimal medical therapy; those with abnormal CVR were offered revascularization where feasible. We determined the incidence of stroke at 1 year. RESULTS: 83 patients were included in the study. CVR was normal in 14 patients and impaired in 69 patients ipsilateral to the lesion. Of these, 53 underwent surgical revascularization. CVR and symptoms improved in 86% of the latter. The overall incidence of stroke was 4.8 % (4/83). All strokes occurred in patients with impaired CVR (4/69; 2/53 in the surgical group, all in the nonrevascularized hemisphere), and none in patients with normal CVR (0/14). CONCLUSION: Our study confirms that CO2-BOLD MRI CVR can be used as a brain stress test for the assessment of cerebrovascular reserve. Impaired CVR is associated with a higher incidence of stroke and normal CVR despite significant stenosis is associated with a low risk for stroke.
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Dióxido de Carbono / Accidente Cerebrovascular Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Can J Neurol Sci Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido
Texto completo
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Texto completo: 1 Colección: 01-internacional Base de datos: MEDLINE Asunto principal: Dióxido de Carbono / Accidente Cerebrovascular Tipo de estudio: Etiology_studies / Observational_studies / Risk_factors_studies Límite: Humans Idioma: En Revista: Can J Neurol Sci Año: 2024 Tipo del documento: Article País de afiliación: Canadá Pais de publicación: Reino Unido