Blood flow response to orthostatic challenge identifies signatures of the failure of static cerebral autoregulation in patients with cerebrovascular disease
Clara Gregori-Pla,
Rickson C. Mesquita,
Christopher G. Favilla,
David R. Busch,
Igor Blanco,
Peyman Zirak,
Lisa Kobayashi Frisk,
Stella Avtzi,
Federica Maruccia,
Giacomo Giacalone,
Gianluca Cotta,
Pol Camps-Renom,
Michael T. Mullen,
Joan Martí-Fàbregas,
Luís Prats-Sánchez,
Alejandro Martínez-Domeño,
Scott E. Kasner,
Joel H. Greenberg,
Chao Zhou,
Brian L. Edlow,
Mary E. Putt,
John A. Detre,
Arjun G. Yodh,
Turgut Durduran,
Raquel Delgado-Mederos
Affiliations
Clara Gregori-Pla
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Rickson C. Mesquita
Institute of Physics, University of Campinas
Christopher G. Favilla
Department of Neurology, University of Pennsylvania
David R. Busch
Departments of Anesthesiology and Pain Management and Neurology, University of Texas Southwestern Medical Center
Igor Blanco
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Peyman Zirak
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Lisa Kobayashi Frisk
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Stella Avtzi
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Federica Maruccia
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Giacomo Giacalone
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Gianluca Cotta
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Pol Camps-Renom
Department of Neurology (Stroke Unit). Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau)
Michael T. Mullen
Department of Neurology, University of Pennsylvania
Joan Martí-Fàbregas
Department of Neurology (Stroke Unit). Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau)
Luís Prats-Sánchez
Department of Neurology (Stroke Unit). Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau)
Alejandro Martínez-Domeño
Department of Neurology (Stroke Unit). Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau)
Scott E. Kasner
Department of Neurology, University of Pennsylvania
Joel H. Greenberg
Department of Neurology, University of Pennsylvania
Chao Zhou
McKelvey School of Engineering, Washington University in St. Louis
Brian L. Edlow
Center for Neurotechnology and Neurorecovery, Massachusetts General Hospital
Mary E. Putt
Department of Biostatistics and Epidemiology, University of Pennsylvania
John A. Detre
Department of Neurology, University of Pennsylvania
Arjun G. Yodh
Department of Physics and Astronomy, University of Pennsylvania
Turgut Durduran
ICFO-Institut de Ciències Fotòniques, The Barcelona Institute of Science and Technology
Raquel Delgado-Mederos
Department of Neurology (Stroke Unit). Hospital de la Santa Creu i Sant Pau, Biomedical Research Institute Sant Pau (IIB Sant Pau)
Abstract Background The cortical microvascular cerebral blood flow response (CBF) to different changes in head-of-bed (HOB) position has been shown to be altered in acute ischemic stroke (AIS) by diffuse correlation spectroscopy (DCS) technique. However, the relationship between these relative ΔCBF changes and associated systemic blood pressure changes has not been studied, even though blood pressure is a major driver of cerebral blood flow. Methods Transcranial DCS data from four studies measuring bilateral frontal microvascular cerebral blood flow in healthy controls (n = 15), patients with asymptomatic severe internal carotid artery stenosis (ICA, n = 27), and patients with acute ischemic stroke (AIS, n = 72) were aggregated. DCS-measured CBF was measured in response to a short head-of-bed (HOB) position manipulation protocol (supine/elevated/supine, 5 min at each position). In a sub-group (AIS, n = 26; ICA, n = 14; control, n = 15), mean arterial pressure (MAP) was measured dynamically during the protocol. Results After elevated positioning, DCS CBF returned to baseline supine values in controls (p = 0.890) but not in patients with AIS (9.6% [6.0,13.3], mean 95% CI, p < 0.001) or ICA stenosis (8.6% [3.1,14.0], p = 0.003)). MAP in AIS patients did not return to baseline values (2.6 mmHg [0.5, 4.7], p = 0.018), but in ICA stenosis patients and controls did. Instead ipsilesional but not contralesional CBF was correlated with MAP (AIS 6.0%/mmHg [− 2.4,14.3], p = 0.038; ICA stenosis 11.0%/mmHg [2.4,19.5], p < 0.001). Conclusions The observed associations between ipsilateral CBF and MAP suggest that short HOB position changes may elicit deficits in cerebral autoregulation in cerebrovascular disorders. Additional research is required to further characterize this phenomenon.
