Assessing the effect of unilateral cerebral revascularisation on the vascular reactivity of the non-intervened hemisphere: a retrospective observational study

Objectives Unilateral haemodynamically significant large-vessel intracranial stenosis may be associated with reduced blood-oxygen-level-dependent (BOLD) cerebrovascular reactivity (CVR), an indicator of autoregulatory reserve. Reduced CVR has been associated with ipsilateral cortical thinning and lo...

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Bibliographic Details
Published in:BMJ open 2015-02, Vol.5 (2), p.e006014-e006014
Main Authors: Sam, Kevin, Poublanc, Julien, Sobczyk, Olivia, Han, Jay S, Battisti-Charbonney, Anne, Mandell, Daniel M, Tymianski, Michael, Crawley, Adrian P, Fisher, Joseph A, Mikulis, David J
Format: Article
Language:English
Subjects:
Adolescent
Adult
Aged
Atherosclerosis - surgery
Brain - blood supply
Brain - surgery
Brain research
Carbon Dioxide - blood
Cerebral Revascularization
Cerebrovascular Circulation
Disease
Female
Hemodynamics
Humans
Intracranial Arteriosclerosis - surgery
Ischemia
Magnetic Resonance Imaging
Male
Middle Aged
Middle Cerebral Artery
Moyamoya Disease - surgery
Neurology
Oxygen - blood
Patients
Retrospective Studies
Software
Stroke
Time series
Variance analysis
Veins & arteries
Young Adult
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Summary:Objectives Unilateral haemodynamically significant large-vessel intracranial stenosis may be associated with reduced blood-oxygen-level-dependent (BOLD) cerebrovascular reactivity (CVR), an indicator of autoregulatory reserve. Reduced CVR has been associated with ipsilateral cortical thinning and loss in cognitive function. These effects have been shown to be reversible following revascularisation. Our aim was to study the effects of unilateral revascularisation on CVR in the non-intervened hemisphere in bilateral steno-occlusive or Moyamoya disease. Study Design A retrospective observational study. Setting A routine follow-up assessment of CVR after a revascularisation procedure at a research teaching hospital in Toronto (Journal wants us to generalise). Participants Thirteen patients with bilateral Moyamoya disease (age range 18 to 52 years; 3 males), seven patients with steno-occlusive disease (age range 18 to 78 years; six males) and 27 approximately age-matched normal control subjects (age range 19–71 years; 16 males) with no history or findings suggestive of any neurological or systemic disease. Intervention Participants underwent BOLD CVR MRI using computerised prospective targeting of CO2, before and after unilateral revascularisation (extracranial–intracranial bypass, carotid endarterectomy or encephaloduroarteriosynangiosis). Pre-revascularisation and post-revascularisation CVR was assessed in each major arterial vascular territory of both hemispheres. Results As expected, surgical revascularisation improved grey matter CVR in the middle cerebral artery (MCA) territory of the intervened hemisphere (0.010±0.023 to 0.143±0.010%BOLD/mm Hg, p
ISSN:2044-6055
2044-6055
DOI:10.1136/bmjopen-2014-006014