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Mariani J, Beretta S, Diamanti S, Versace A, Martini B, Viganò M, Castiglioni L, Sironi L, Carone D, Cuccione E, Monza L, Giussani C, Ferrarese C. Head Down Tilt 15° in Acute Ischemic Stroke with Poor Collaterals: A Randomized Preclinical Trial. Neuroscience 2023; 523:1-6. [PMID: 37211082 DOI: 10.1016/j.neuroscience.2023.05.011] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2022] [Revised: 05/05/2023] [Accepted: 05/14/2023] [Indexed: 05/23/2023]
Abstract
Cerebral collaterals are recruited after arterial occlusion with a protective effect on tissue outcome in acute ischemic stroke. Head down tilt 15° (HDT15) is a simple, low cost and accessible procedure that could be applied as an emergency treatment, before recanalization therapies, with the aim to increase cerebral collateral flow. Spontaneously hypertensive rats have been shown to display anatomical differences in morphology and function of cerebral collaterals, compared to other rat strains, resulting in an overall poor collateral circulation. We investigate the efficacy and safety of HDT15 in spontaneously hypertensive (SHR) rats, which were considered as an animal stroke model with poor collaterals. Cerebral ischemia was induced by 90 minute endovascular occlusion of the middle cerebral artery (MCA). SHR rats were randomized to HDT15 or flat position (n = 19). HDT15 was applied 30 minutes after occlusion and lasted 60 minutes, until reperfusion. HDT15 application increased cerebral perfusion (+16.6% versus +6.1%; p = 0.0040) and resulted in a small reduction of infarct size (83.6 versus 107.1 mm3; - 21.89%; p = 0.0272), but it was not associated with early neurological improvement, compared to flat position. Our study suggests that the response to HDT15 during MCA occlusion is dependent on baseline collaterals. Nonetheless, HDT15 promoted a mild improvement of cerebral hemodynamics even in subjects with poor collaterals, without safety concerns.
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Affiliation(s)
- Jacopo Mariani
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy; Milan Center for Neuroscience (NeuroMi), Milano, Italy.
| | - Simone Beretta
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy; Milan Center for Neuroscience (NeuroMi), Milano, Italy; Department of Neuroscience, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900 Monza (MB), Italy
| | - Susanna Diamanti
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy; Milan Center for Neuroscience (NeuroMi), Milano, Italy; Department of Neuroscience, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900 Monza (MB), Italy
| | - Alessandro Versace
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | - Beatrice Martini
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | - Martina Viganò
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | - Laura Castiglioni
- Department of Pharmacology, University of Milan, Via Balzaretti 9, 20133 Milano (MI), Italy
| | - Luigi Sironi
- Department of Pharmacology, University of Milan, Via Balzaretti 9, 20133 Milano (MI), Italy
| | - Davide Carone
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | - Elisa Cuccione
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | - Laura Monza
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy
| | - Carlo Giussani
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy; Milan Center for Neuroscience (NeuroMi), Milano, Italy; Department of Neuroscience, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900 Monza (MB), Italy
| | - Carlo Ferrarese
- Laboratory of Experimental Stroke Research, School of Medicine and Surgery, University of Milano Bicocca, Via Cadore 48, 20900 Monza (MB), Italy; Milan Center for Neuroscience (NeuroMi), Milano, Italy; Department of Neuroscience, San Gerardo Hospital, ASST Monza, Via Pergolesi 33, 20900 Monza (MB), Italy
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Wang H, Chai C, Wu G, Li J, Zhao C, Fu D, Zhang S, Wang H, Wang B, Zhu J, Shen W, Xia S. Cerebral blood flow regulates iron overload in the cerebral nuclei of hemodialysis patients with anemia. J Cereb Blood Flow Metab 2023; 43:749-762. [PMID: 36545834 PMCID: PMC10108183 DOI: 10.1177/0271678x221147363] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/24/2022] [Revised: 09/16/2022] [Accepted: 10/09/2022] [Indexed: 12/24/2022]
Abstract
Hemodialysis patients exhibit anemia-related cerebral hyperperfusion and iron deposition (ID). However, the mechanisms underlying the pathology of cerebral ID are not clear. We investigated the role of cerebral blood flow (CBF) in the pathophysiology of cerebral ID in hemodialysis patients with anemia. This study recruited 33 hemodialysis patients with anemia and thirty-three healthy controls (HCs). All the subjects underwent quantitative susceptibility mapping (QSM) and arterial spin labeling (ASL) to measure ID and CBF in the cerebral nuclei. Furthermore, we evaluated lacunar infarction (LI), cerebral microbleeds, and total white matter hyperintensity volume (TWMHV). Hemodialysis patients with anemia showed significantly higher ID and CBF in some nuclei compared to the HCs after adjusting for age, sex, and total intracranial volume (TIV) [P < 0.05, false discovery rate (FDR) corrected]. CBF showed a positive correlation with ID in both patients and HCs after adjustments for age, gender, and TIV (P < 0.05, FDR corrected). Serum phosphorus, calcium, TWMHV, hypertension, and dialysis duration were independently associated with ID (P < 0.05). Hemoglobin, serum phosphorus, and LI were independently associated with CBF (P < 0.05). Mediation analysis demonstrated that CBF mediated the effects between hemoglobin and ID. Our study demonstrated that CBF mediated aberrant cerebral ID in hemodialysis patients with anemia.
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Affiliation(s)
- Huiying Wang
- The School of Medicine, Nankai
University, Tianjin, China
| | - Chao Chai
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
| | - Gemuer Wu
- The School of Medicine, Nankai
University, Tianjin, China
| | - Jinping Li
- Department of Hemodialysis, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
| | - Chenxi Zhao
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Dingwei Fu
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | | | - Huapeng Wang
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Beini Wang
- Department of Radiology, First
Central Clinical College, Tianjin Medical University, Tianjin, China
| | - Jinxia Zhu
- MR Collaboration, Siemens
Healthcare, Northeast Asia, Beijing, China
| | - Wen Shen
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
| | - Shuang Xia
- Department of Radiology, Tianjin
First Central Hospital, School of Medicine, Nankai University, Tianjin,
China
- Imaging Medicine Institute of
Tianjin, Tianjin, China
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Deseoe J, Schwarz A, Pipping T, Lehmann A, Veerbeek JM, Luft AR, Wegener S, Globas C, Held JPO. Cerebral blood flow velocity progressively decreases with increasing levels of verticalization in healthy adults. A cross-sectional study with an observational design. Front Neurol 2023; 14:1149673. [PMID: 37139076 PMCID: PMC10149656 DOI: 10.3389/fneur.2023.1149673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/22/2023] [Accepted: 03/20/2023] [Indexed: 05/05/2023] Open
Abstract
Background Autoregulation of the cerebral vasculature keeps brain perfusion stable over a range of systemic mean arterial pressures to ensure brain functioning, e.g., in different body positions. Verticalization, i.e., transfer from lying (0°) to upright (70°), which causes systemic blood pressure drop, would otherwise dramatically lower cerebral perfusion pressure inducing fainting. Understanding cerebral autoregulation is therefore a prerequisite to safe mobilization of patients in therapy. Aim We measured the impact of verticalization on cerebral blood flow velocity (CBFV) and systemic blood pressure (BP), heart rate (HR) and oxygen saturation in healthy individuals. Methods We measured CBFV in the middle cerebral artery (MCA) of the dominant hemisphere in 20 subjects using continuous transcranial doppler ultrasound (TCD). Subjects were verticalized at 0°, -5°, 15°, 30°, 45° and 70° for 3-5 min each, using a standardized Sara Combilizer chair. In addition, blood pressure, heart rate and oxygen saturation were continuously monitored. Results We show that CBFV progressively decreases in the MCA with increasing degrees of verticalization. Systolic and diastolic BP, as well as HR, show a compensatory increase during verticalization. Conclusion In healthy adults CBFV changes rapidly with changing levels of verticalization. The changes in the circulatory parameters are similar to results regarding classic orthostasis. Registration ClinicalTrials.gov, identifier: NCT04573114.
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Affiliation(s)
- Julian Deseoe
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Anne Schwarz
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Theodor Pipping
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Aurelia Lehmann
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Janne M. Veerbeek
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Neurocenter, Luzerner Kantonsspital, Lucerne, Switzerland
| | - Andreas R. Luft
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Susanne Wegener
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
| | - Christoph Globas
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- *Correspondence: Christoph Globas
| | - Jeremia P. O. Held
- Department of Neurology, University Hospital Zurich and University of Zurich, Zurich, Switzerland
- Rehabilitation Center Triemli Zurich, Valens Clinics, Zurich, Switzerland
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Xia C, Zhou J, Lu C, Wang Y, Tang T, Cai Y, Ju S. Characterizing Diaschisis-Related Thalamic Perfusion and Diffusion After Middle Cerebral Artery Infarction. Stroke 2021; 52:2319-2327. [PMID: 33971741 DOI: 10.1161/strokeaha.120.032464] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
[Figure: see text].
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Affiliation(s)
- Cong Xia
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Jiaying Zhou
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Chunqiang Lu
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Yuancheng Wang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Tianyu Tang
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Yu Cai
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
| | - Shenghong Ju
- Jiangsu Key Laboratory of Molecular and Functional Imaging, Department of Radiology, Zhongda Hospital, Medical School of Southeast University, Nanjing, China
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Bambach S, Smith M, Morris PP, Campeau NG, Ho ML. Arterial Spin Labeling Applications in Pediatric and Adult Neurologic Disorders. J Magn Reson Imaging 2020; 55:698-719. [PMID: 33314349 DOI: 10.1002/jmri.27438] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2020] [Revised: 10/26/2020] [Accepted: 10/27/2020] [Indexed: 12/17/2022] Open
Abstract
Arterial spin labeling (ASL) is a powerful noncontrast magnetic resonance imaging (MRI) technique that enables quantitative evaluation of brain perfusion. To optimize the clinical and research utilization of ASL, radiologists and physicists must understand the technical considerations and age-related variations in normal and disease states. We discuss advanced applications of ASL across the lifespan, with example cases from children and adults covering a wide variety of pathologies. Through literature review and illustrated clinical cases, we highlight the subtleties as well as pitfalls of ASL interpretation. First, we review basic physical principles, techniques, and artifacts. This is followed by a discussion of normal perfusion variants based on age and physiology. The three major categories of perfusion abnormalities-hypoperfusion, hyperperfusion, and mixed patterns-are covered with an emphasis on clinical interpretation and relationship to the disease process. Major etiologies of hypoperfusion include large artery, small artery, and venous disease; other vascular conditions; global hypoxic-ischemic injury; and neurodegeneration. Hyperperfusion is characteristic of vascular malformations and tumors. Mixed perfusion patterns can be seen with epilepsy, migraine, trauma, infection/inflammation, and toxic-metabolic encephalopathy. LEVEL OF EVIDENCE: 4 TECHNICAL EFFICACY STAGE: 3.
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Affiliation(s)
- Sven Bambach
- Abigail Wexner Research Institute, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - Mark Smith
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA
| | - P Pearse Morris
- Department of Radiology, Mayo Clinic, Rochester, Minnesota, USA
| | | | - Mai-Lan Ho
- Department of Radiology, Nationwide Children's Hospital, Columbus, Ohio, USA
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Arterial hypertension and cerebral hemodynamics: impact of head-down tilt on cerebral blood flow (arterial spin-labeling-MRI) in healthy and hypertensive patients. J Hypertens 2020; 39:979-986. [PMID: 33306520 DOI: 10.1097/hjh.0000000000002709] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
OBJECTIVE Hypertension affects cerebrovascular autoregulation and increases the risk of cerebrovascular events and dementia. Notably, it is associated with cerebrovascular remodeling and lower resting cerebral blood flow (CBF). We wanted to determine, using arterial spin-labeling-MRI, the impact of a head-down tilt (HDT) dynamic maneuver on CBF in hypertensive patients. METHODS The current prospective study measured 36 patients' CBFs (18 normotensive individuals; 18 hypertensive patients) on 1.5T arterial spin-labeling-MRI in the supine position and after 4 min at -15° HDT. We reconstructed CBF maps of left and right subcortical nuclear gray matter, cortical gray matter and white matter (16 structures) to explore cerebrovascular autoregulation modification under dynamic conditions. RESULTS Normotensive and hypertensive participants had no significant CBF differences in the supine position. After HDT, CBF mean variations (CBF-mVs) across all structures declined (mean -5.8%) for the whole population (n = 36), with -6.6 and -7.6% decreases, respectively, in white matter and gray matter (P < 0.001). Left and right accumbens nuclei had the largest changes (-9.6 and -9.2%, respectively; P < 0.001). No CBF-mV difference (0/16) was found in hypertensive patients after HDT, whereas normotensive participants' CBF-mVs changed significantly in four structures (left and right accumbens, putamen and left caudate nucleus) and gray matter. Hypertensive patients exhibited fewer CBF-mVs in left caudate nuclei (P = 0.039) and cortical gray matter (P = 0.013). Among hypertensive patients, people with diabetes had smaller CBF-mVs than people without diabetes. CONCLUSION Our results highlight the significantly different CBF reactions to HDT of normotensive and hypertensive participants. They support the hypothesis that hypertension is responsible for deficient cerebrovascular autoregulation.
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