Abstract
Background and PurposeDynamic cerebral autoregulation (dCA) in acute ischemic stroke is probably compromised. Although the characteristics of dCA in different types of stroke have been largely investigated, dCA in embolic stroke of undetermined source (ESUS) remains poorly understood. In this group, we aimed to elucidate the characteristics of dCA and their relevance to clinical outcomes.MethodsThe study enrolled 77 ESUS patients and 50 controls. Bilateral cerebral blood flow velocities (CBFV) of middle cerebral arteries and arterial blood pressure were simultaneously recorded using a transcranial Doppler combined with a servo-controlled finger plethysmograph. Transfer function analysis was used to obtain dCA parameters including phase, gain, coherence at very low frequency (VLF) and low frequency (LF), and the rate of recovery (RoRc) of CBFV. A multivariable logistic regression model was established to explore the relationship between dCA and clinical outcomes.ResultsGain at VLF and LF, phase at LF, and RoRc of CBFV in bilateral hemispheres of the ESUS group were consistently worse than those of the control group (all P < 0.001). Bilateral RoRc of CBFV was significantly higher in patients with favorable outcomes than in those with unfavorable outcomes (stroke hemisphere: P < 0.001; non-stroke hemisphere, P = 0.029). Rate of recovery of CBFV in stroke hemisphere >13.3%/s was an independent predictor of favorable clinical outcomes (adjusted odds ratio = 30.95, 95% CI: 5.33–179.81, P < 0.001).ConclusionsDynamic cerebral autoregulation was relatively impaired in both stroke and non-stroke hemispheres in ESUS patients, and functioning dCA after ESUS may indicate favorable clinical outcomes.
Highlights
Cerebral autoregulation (CA) maintains cerebral blood flow (CBF) at an approximately constant level within a certain range of arterial blood pressure (ABP) fluctuations (Lassen, 1959)
The use of transcranial Doppler (TCD) in clinical practice has led to the gradual acceptance of dynamic cerebral autoregulation, which characterizes the temporal capacity of CBF recovery dCA in embolic stroke of undetermined source (ESUS)
Dynamic cerebral autoregulation in acute ischemic stroke (AIS) patients is impaired to a certain degree, and the evidence accumulated over recent years suggests that dCA enables good prediction of clinical outcomes (Castro et al, 2017; Chi et al, 2018; Ma et al, 2018; Intharakham et al, 2019)
Summary
Cerebral autoregulation (CA) maintains cerebral blood flow (CBF) at an approximately constant level within a certain range of arterial blood pressure (ABP) fluctuations (Lassen, 1959). Dynamic cerebral autoregulation in acute ischemic stroke (AIS) patients is impaired to a certain degree, and the evidence accumulated over recent years suggests that dCA enables good prediction of clinical outcomes (Castro et al, 2017; Chi et al, 2018; Ma et al, 2018; Intharakham et al, 2019). The characteristics of dCA in different types of stroke have been largely investigated, dCA in embolic stroke of undetermined source (ESUS) remains poorly understood. In this group, we aimed to elucidate the characteristics of dCA and their relevance to clinical outcomes
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
