Cerebral Hemodynamic Parameters Research Articles

Early Microcirculatory Dysfunction on Perfusion CT Is Related to Prognosis After Aneurysmal Subarachnoid Hemorrhage.

Microcirculatory dysfunction is an important pathophysiology mechanism of early brain injury after aneurysmal subarachnoid hemorrhage (aSAH), which contributes to poor outcomes. The study was performed in Beijing Tiantan Hospital from October 2020 to July 2023. Patients with aSAH who underwent computed tomographic perfusion (CTP) within 24h after ictus were enrolled prospectively. The peak time of arterial inflow (PTA), peak time of venous outflow (PTV), total venous outflow time (TVT), and difference value of arteriovenous peak time (DV) were collected from the time-density curve of CTP. Primary outcome was 3-month unfavorable functional outcome (modified Rankin Scale score of 4-6). Secondary outcomes included 3-month all-cause death and delayed cerebral ischemia. Multivariable logistic regression analysis and restricted cubic splines were performed to explore the relationship between cerebral hemodynamic parameters and outcomes. We also assessed the prognostic performance of incorporating hemodynamic parameters into previous nomogram models for 3-month poor clinical outcomes. A total of 612 patients were enrolled, among whom the mean age was 56.9 ± 12.3years old and 391 (63.9%) were female. On multivariable analysis, prolonged TVT could significantly predict 3-month poor functional outcome (adjusted OR 1.074, 95%CI 1.013-1.139), while prolonged PTA was an independent predictor of 3-month all-cause death (adjusted OR 1.293, 95%CI 1.099-1.521). The addition of TVT or PTA to previous nomogram models led to improvements in C-statistics, net reclassification (NRI), and integrated discrimination improvement (IDI). Our study underscores the vital role of arterial inflow and venous outflow in sustaining microcirculation during the acute phase after aSAH, thereby offering new directions for future investigations into therapeutic targets.

Parameters of oculomotor activity and cerebral hemodynamics in students with different types of autonomic reactivity while performing cognitive tasks

BACKGROUND: At the current state of human development, with the high rates of knowledge accumulation and accelerated social and technical evolution, studying the psychophysiological features of cognitive activity within a limited time is essential. AIM: To examine oculomotor activity and cerebral hemodynamics parameters in students with different types of autonomic reactivity while performing cognitive tasks. MATERIALS AND METHODS: The study enrolled 110 students of the Northern (Arctic) Federal University named after M.V. Lomonosov (mean age, 19.0±0.5 years). To identify specific features of cognitive activity in various timing conditions, the type of autonomic nervous system reactivity was determined. Eye movements were tracked when solving cognitive tasks at various timing conditions. A rheoencephalogram was simultaneously recorded to assess cerebral hemodynamics. The efficiency of cognitive activity was assessed in various timing conditions with consideration of the identified individual typological features. RESULTS: The participants demonstrated different efficiency levels of cognitive activity when performing cognitive tasks at various timing conditions. Students with a sympathetic-tone type of autonomic reactivity revealed the most efficient and rapid processing of visual information under a time-constraint setting owing to the presence of a more stable relationship between oculomotor activity and cerebral hemodynamics parameters. Participants with parasympathetic-tone reactivity showed the lowest success rates in cognitive activity and the least stable relationships between oculomotor activity and cerebral hemodynamics. CONCLUSIONS: Young individuals with different types of autonomic reactivity exhibited general and specific alterations in cerebral hemodynamics and oculomotor activity when performing cognitive tasks under a time-constraint setting. They showed different efficiency levels of cognitive activity. Thus, human cognitive abilities under stress depend on the reactivity type of the nervous system. The specific changes in oculomotor reactions and cerebral hemodynamics parameters may be considered success markers of cognitive activity. The most successful cognitive activity under limited time conditions is ensured with a more stable statistical relationship between cerebral hemodynamics and oculomotor activity parameters. This is reflected in a stable factor model of visual cognitive activity, regardless of time limitations.

The Impact of Blood Pressure Below Personalized Lower Cerebral Autoregulation Limit on Outcomes After Cardiac Surgery: A Retrospective Study.

The clinical importance of individualized blood pressure management in optimizing cerebral perfusion during cardiac surgery has been well established. However, consensus on blood pressure goals is lacking. The authors studied the associations between cerebral autoregulation metrics, hemodynamic parameters, and postoperative outcomes, and hypothesized that increased time of mean arterial pressure (MAP) below the lower limit of autoregulation (LLA) is associated with major morbidity and mortality (MMOM) incidence. A retrospective, observational study. A university hospital. A total of 686 cardiovascular surgeries were included. None. The area under the time-pressure curve (AUC) for MAP < LLA and time below LLA (AUCABP<LLA) were analyzed for associations with stroke, acute kidney injury, low cardiac output syndrome, mechanical ventilation lasting >48 hours, and postoperative mortality (ie, MMOM). There was no significant association between AUCABP<LLA and MMOM (p > 0.05). Relationships were observed between components of MMOM-operative mortality (p < 0.05) and low cardiac output syndrome (p < 0.05)-and AUCABP<LLA, when controlling for preoperative hemoglobin levels and logistic EuroSCORE. These findings indicate that LLA-related metrics have limited utility for predicting MMOM. Future research should explore their applicability in various contexts and patient cohorts.

Negative pressure breathing: the response of human respiration and circulation to different levels of rarefaction during inspiration.

Negative pressure breathing is breathing with decreased pressure in the respiratory tract without lowering pressure acting on the torso. We lowered pressure only during inspiration (NPBin). NPBin is used to increase venous return to the heart and is considered as a countermeasure against redistribution of body fluids toward the head during spaceflight. Aims of our study were: to obtain quantitative information on NPBin-induced changes in parameters of circulation and respiration in healthy human at various rarefactions; to identify main processes involved in cardiorespiratory response to NPBin. Cardiorespiratory response to 25min of NPBin were studied, rarefaction ranged from -10 to -25cmH2O. Parameters of systemic, cerebral, and peripheral hemodynamics, as well as respiratory and gas exchange parameters, were measured with non-invasive methods (Finometer, impedance cardiography, rheoencephalography, transcranial Doppler ultrasonography, laser Doppler flowmetry, capillaroscopy). Concentrations of endothelin-1, atrial and brain natriuretic peptides precursors in venous blood, O2 and CO2 tensions in arterialized capillary blood were measured. Tidal volume increased, respiratory rate decreased under NPBin with no significant changes in minute ventilation. Group averaged, respiratory rate and tidal volume changed approximately twice relative to their values observed under normal breathing. Despite the decrease in respiratory rate (up to 2-3 breaths/min), the results indicate CO2 wash-out. Changes in respiratory and gas exchange parameters were virtually independent of rarefaction level. Synchronous with breathing oscillations of circulatory parameters increased in amplitude under NPBin, while values of the parameters averaged over NPBin period changed little. Amplitude of oscillations in parameters associated with arteries virtually did not change with increasing rarefaction. Inspiration under NPBin reduced left ventricle stroke volume and arterial blood pressure, increased heart rate. Head blood filling decreased during inspiration under NPBin, the decrease increased almost linearly with increasing rarefaction. Parameters returned to their initial values after the end of inspiration. Peak-to-peak amplitude of oscillations under NPBin ranged: stroke volume 17-25mL, mean arterial pressure 7-9mmHg, heart rate 14-18bpm. Peripheral hemodynamics responded to NPBin little. Changes in stroke volume and central venous pressure during inspiration under NPBin appear to be the major phenomena mediating the effects of NPBin on the cardiorespiratory system.

Correlation between antihypertensive drugs and cerebral hemodynamic parameters: insights from observational findings using transcranial Doppler.

Antihypertensives (AHD) can influence cerebral autoregulation (CA) and attenuate hypertrophic concentric remodelling of arterioles. The aim of this study was to examine the associations between AHD, CA and structural and functional properties of cerebral arteries. In this observational, cross-sectional study 115 volunteers were divided in group 1 (non-hypertensive) [n = 30]; group 2 (hypertensive with systolic blood pressure [SBP] < 140 and diastolic blood pressure [DBP] < 90 mmHg) [n = 54]; group 3 (hypertensive with SBP ≥ 140 or DBP ≥ 90 mmHg) [n = 31] and simultaneous measurements of systemic blood pressure (BP) and middle cerebral artery blood flow velocity (CBFV) were obtained from digital plethysmography and transcranial Doppler. Beat-to-beat, critical closing pressure (CrCP), resistance-area product (RAP) and autoregulation index (ARI) values were extracted by linear regression analysis of instantaneous BP and CBFV waveforms using computerised analysis. Pulsatility index (PI) was calculated and CO2 reactivity was assessed by the breath-holding test. Despite their higher RAP (1.7 [±0.7], p < 0.001) compared to groups 1 and 2, uncontrolled hypertensive using diuretics (p = 0.047) and α2-agonists (p = 0.009) had significantly lower PI. Impaired CO2 reactivity was common between the two hypertensive groups (p = 0.008), however ARI, CrCP and CBFV did not differ between them and non-hypertensive individuals and also did not correlate with any AHD used. Unlike the RAP, PI does not seem to reflect the real cerebrovascular resistence resulting from chronic arterial remodelling. Despite impaired CO2 reactivity, hypertensivehavearterial tonus and CA comparable to non-hypertensive. Experimental studies involving an untreated hypertensive control group are required to robustly make definitive conclusions about these questions.

The efficacy and mechanism of action of the Umei decoction in insomnia: A randomized active-controlled clinical trial

Insomnia, affecting the quality of life of millions globally, necessitates urgent and effective treatment strategies. This study conducted a randomized controlled trial to compare traditional and novel treatment methods in a cohort of 60 insomnia patients. Sleep quality and symptoms were assessed using the Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Dysfunctional Beliefs and Attitudes about Sleep Scale (DBAS). Additionally, transcranial Doppler (TCD) technology was employed to measure cerebral hemodynamic parameters. We divided the patients into two groups for insomnia treatment: (1) Control group: oral administration of zopiclone tablets; (2) Treatment group: oral administration of WuMei Decoction. The findings revealed that novel treatment approaches significantly improved sleep quality, disturbances, daytime functionality, and cerebral hemodynamic indicators. Furthermore, identifying 220 potential target genes through systems biology approaches offers new insights into the molecular mechanisms of insomnia and opportunities for drug development.

A Multi-Parametric Approach for Characterising Cerebral Haemodynamics in Acute Ischaemic and Haemorrhagic Stroke.

Early differentiation between acute ischaemic (AIS) and haemorrhagic stroke (ICH), based on cerebral and peripheral hemodynamic parameters, would be advantageous to allow for pre-hospital interventions. In this preliminary study, we explored the potential of multiple parameters, including dynamic cerebral autoregulation, for phenotyping and differentiating each stroke sub-type. Eighty patients were included with clinical stroke syndromes confirmed by computed tomography within 48 h of symptom onset. Continuous recordings of bilateral cerebral blood velocity (transcranial Doppler ultrasound), end-tidal CO2 (capnography), electrocardiogram (ECG), and arterial blood pressure (ABP, Finometer) were used to derive 67 cerebral and peripheral parameters. A total of 68 patients with AIS (mean age 66.8 ± SD 12.4 years) and 12 patients with ICH (67.8 ± 16.2 years) were included. The median ± SD NIHSS of the cohort was 5 ± 4.6. Statistically significant differences between AIS and ICH were observed for (i) an autoregulation index (ARI) that was higher in the unaffected hemisphere (UH) for ICH compared to AIS (5.9 ± 1.7 vs. 4.9 ± 1.8 p = 0.07); (ii) coherence function for both hemispheres in different frequency bands (AH, p < 0.01; UH p < 0.02); (iii) a baroreceptor sensitivity (BRS) for the low-frequency (LF) bands that was higher for AIS (6.7 ± 4.2 vs. 4.10 ± 2.13 ms/mmHg, p = 0.04) compared to ICH, and that the mean gain of the BRS in the LF range was higher in the AIS than in the ICH (5.8 ± 5.3 vs. 2.7 ± 1.8 ms/mmHg, p = 0.0005); (iv) Systolic and diastolic velocities of the affected hemisphere (AH) that were significantly higher in ICH than in AIS (82.5 ± 28.09 vs. 61.9 ± 18.9 cm/s), systolic velocity (p = 0.002), and diastolic velocity (p = 0.05). Further multivariate modelling might improve the ability of multiple parameters to discriminate between AIS and ICH and warrants future prospective studies of ultra-early classification (<4 h post symptom onset) of stroke sub-types.

HIGH SALT DIET EFFECTS ON CEREBRAL AND SYSTEM HEMODYNAMICS IN RESPONSE TO BREATH HOLDING TEST AND HYPERVENTILATION

Objective: High salt (HS) diet impairs endothelium-dependent vasodilation in many vascular beds, including cerebral microcirculation, and may affect vascular resistance. The aim of present study was to determine if 7-day HS diet affected cerebral and system hemodynamics in response to breath holding test (BHT) and hyperventilation in healthy young persons. Design and method: In this controlled intervention study 27 persons participated (F:21, M:6, age range 19-24). Participants consumed 7-day low salt (LS) diet (&lt;2.3g NaCl/day) and afterwards 7-day of HS diet (&gt;11.2g NaCl/day). Blood and urine analysis and anthropometric measurements were performed after each diet. Arterial blood pressure, heart rate and heart rate variability (HRV), cerebral and systemic hemodynamic parameters were recorded simultaneously with transcranial Doppler ultrasound and the Task Force® Monitor in response to BHT and hyperventilation. Results: The subjects remained normotensive during both protocols. After hyperventilation test, HS diet did not affect parameters of cerebral or systemic hemodynamics. HRV was more decreased after HS diet, while baroreceptor sensitivity (BRS) decreased in both LS and HS diet. Similar lack of effects of HS diet on cerebral and system hemodynamics was observed in BHT. Urine concentration of noradrenaline and vanillylmandelic acid was significantly decreased by HS diet. Conclusions: Results suggest that HS diet suppresses sympathetic activity. However, physiological hemodynamic responses to BHT and hyperventilation are preserved, which could be contributed to salt-resistant phenotype of participants and some, still unexplained (chemoreceptors-mediated) compensatory mechanisms preserving cerebral and systemic blood flow.

Wearable fiber-free optical sensor for continuous monitoring of neonatal cerebral blood flow and oxygenation.

Unstable cerebral hemodynamics places preterm infants at high risk of brain injury. We adapted an innovative, fiber-free, wearable diffuse speckle contrast flow-oximetry (DSCFO) device for continuous monitoring of both cerebral blood flow (CBF) and oxygenation in neonatal piglets and preterm infants. DSCFO uses two small laser diodes as focused-point and a tiny CMOS camera as a high-density two-dimensional detector to detect spontaneous spatial fluctuation of diffuse laser speckles for CBF measurement, and light intensity attenuations for cerebral oxygenation measurement. The DSCFO was first validated against the established diffuse correlation spectroscopy (DCS) in neonatal piglets and then utilized for continuous CBF and oxygenation monitoring in preterm infants during intermittent hypoxemia (IH) events. Significant correlations between the DSCFO and DCS measurements of CBF variations in neonatal piglets were observed. IH events induced fluctuations in CBF, cerebral oxygenation, and peripheral cardiorespiratory vitals in preterm infants. However, no consistent correlation patterns were observed among peripheral and cerebral monitoring parameters. This pilot study demonstrated the feasibility of DSCFO technology to serve as a low-cost wearable sensor for continuous monitoring of multiple cerebral hemodynamic parameters. The results suggested the importance of multi-parameter measurements for understanding deep insights of peripheral and cerebral regulations. The innovative DSCFO technology may serve as a low-cost wearable sensor for continuous bedside monitoring of multiple cerebral hemodynamic parameters in neonatal intensive care units. Concurrent DSCFO and DCS measurements of CBF variations in neonatal piglet models generated consistent results. No consistent correlation patterns were observed among peripheral and cerebral monitoring parameters in preterm neonates, suggesting the importance of multi-parameter measurements for understanding deep insights of peripheral and cerebral regulations during IH events. Integrating and correlating multiple cerebral functional parameters with clinical outcomes may identify biomarkers for prediction and management of IH associated brain injury.

Predictive value of intracranial pressure-related parameters and coagulation on the prognosis in patients with traumatic brain injury.

This study investigated the factors affecting the prognosis of patients with traumatic brain injury (TBI) and assessed the predictive value of intracranial pressure-related parameters and coagulation on prognosis. Seventy TBI patients admitted between January 2020 and January 2021 were catego-rized into good prognosis (n=42) and poor prognosis (n=28) groups according to the Glasgow Outcome Scale (GOS) score upon discharge. Factors affecting prognosis were analyzed, and differences in intracranial pressure and coagula-tion between the two groups were compared. The receiver operating charac-teristic curve (ROC) was used to calculate the predictive value of intracranial pressure-related parameters and coagulation function on prognosis. Within 24 h postoperatively, the good prognosis group had lower levels of intracra-nial pressure (ICP) and partial pressure of oxygen in brain tissue (PbtO2) and higher cerebral perfusion pressure (CPP) and cerebral hemodynamic param-eters than the poor prognosis group (p&lt;0.05). The good prognosis group had significantly lower prothrombin time (PT), activated partial thromboplastin time (aPTT),and prothrombin time (TT) levels and higher platelets (PLT) and fibrinogen (Fib) levels than the poor prognosis group (p&lt;0.05). Regression analysis revealed that CPP, systolic blood flow velocity (Vs), end-diastolic blood flow velocity (Vd), mean blood flow velocity (Vm), PLT, Fib were independent protective factors for the prognosis, and ICP, PbtO2, PT, APTT, and TT were risk factors for prognosis. The ROC revealed that ICP, CPP, PbtO2, Vs, Vd, Vm, APTT, PLT, Fib exhibited high diagnostic value for poor prognosis (AUC=0.732, 0.940, 0.796, 0.706, 0.914, 0.729, 0.876, 0.709, 0.866), with ICP showing the highest diagnostic sensitivity and Vd showing the highest diagnostic specificity. Intracranial pressure-related parameters and coagulation indicators are prog-nosis-related indexes in patients with TBI, and the prognosis and survival can be improved by controlling intracranial pressure and improving coagulation.

Research on the classification of early-stage brain edema by combining intrinsic optical signal imaging and laser speckle contrast imaging.

The early detection and pathological classification of brain edema are very important for symptomatic treatment. The dual-optical imaging system (DOIS) consists of intrinsic optical signal imaging (IOSI) and laser speckle contrast imaging (LSCI), which can acquire cerebral hemodynamic parameters of mice in real-time, including changes of oxygenated hemoglobin concentration ( ), deoxyhemoglobin concentration (ΔCHbR) and relative cerebral blood flow (rCBF) within the field of view. The slope sum of , ΔCHbR and rCBF was proposed to classify vasogenic edema (VE) and cytotoxic edema (CE). The slope sum values in the VE and CE group remain statistically different and the classification results provide higher accuracy of more than 93% for early brain edema detection. In conclusion, the differences of hemodynamic parameters between VE and CE in the early stage were revealed and the method helps in the classification of early brain edema.

Cerebral hemodynamic disorders in patients with schizophrenia with concomitant metabolic syndrome

To identify the differences or comparability of parameters of cerebral hemodynamics between patients with schizophrenia with or without concomitant metabolic syndrome (MS). The study included 94 patients with schizophrenia (48 men and 46 women). A control group consisted of 40 mentally and somatically healthy individuals (17 men and 23 women) comparable in sex and age to the main group of patients. The diagnosis of metabolic syndrome was carried out according to the criteria of the International Diabetes Federation (IDF). Assessment of cerebral hemodynamics was carried out by 4 - channel rheoencephalography (REG) at rest with closed eyes. Data analysis was carried out using the Kraskel-Wallis ANOVA criterion with the procedure of automatic a posteriori pairwise comparison, the χ2 criterion and Spearman correlation analysis. According to the IDF criteria, 37 (39.4%) patients were diagnosed with MS. REG results revealed significantly (p<0.05) lower indicators of blood filling in the carotid basin, elasticity of the wall of the main arteries, the tone of small-caliber arteries and arterioles, as well as higher values of the tone of medium-caliber arteries in the carotid and vertebrobasilar basins, in both groups of patients with schizophrenia compared with the control group. In patients with schizophrenia with MS, compared with patients without MS, there were lower indicators of blood filling (p=0.044 and p=0.016) and elasticity of the wall of the main arteries (p=0.044 and p=0.028) in the carotid basin on the left and right sides. The presence of MS in patients with schizophrenia was accompanied by more pronounced disorders of cerebral blood flow in the form of a decrease in blood filling and elasticity of the wall of the main arteries in the carotid basin. The results indicate that patients with schizophrenia with MS should be considered as a group at increased risk of cerebrovascular diseases.

Clinical efficacy and safety of Picamilon in patients with progressive chronic cerebral ischemia

To study the efficacy and safety of the drug Picamilon with various therapy regimens in patients with stage II chronic cerebral ischemia (CCI). An open cohort clinical study involved 50 patients diagnosed with stage II CCI aged 51 to 69 years (average age 62.2±8.98 years). Patients received Picamilon first parenterally 200 mg (100 mg/ml, 2 ml) intravenously for 10 days, then orally in 50 mg tablets 3 times a day for 60 days. The total duration of therapy in the group was 70 days. The study included 3 visits (before treatment, after completion of the course, 1.5 months after completion of treatment). The dynamics of cognitive status according to the Montreal Cognitive Assessment Scale, vegetative disorders according to the A.M. Vane scale, neurological disorders according to the A.I. Fedin scale, and sleep quality according to the Ya. I. Levin scale were compared. The state of cerebral blood flow and endothelium was studied before and after treatment: dopplerography of cranial vessels, assessment of the level of methylated forms of arginine (ADMA, MMA, SDMA) and their ratios. The registration of adverse events against the background of therapy and the tolerability of treatment by patients was also carried out. Against the background of Picamilon treatment, a significant positive dynamics of the MoCA scale results was observed in the general sample of patients, increasing in the delayed period (20.9, 24.6 and 25.9, p<0.0001 and p=0.0006); sleep normalization was observed in 55% of patients by Visit 2 and in 81% of patients by Visit 3 (p<0.0001 and p=0.0025). Improvement of neurological functions is noted in 84% of patients, the score on the Fedin A.I. scale significantly decreases after treatment from 17.4±9.34 to 8.06±6.84 (p<0.0001) and to 5.31±5.71 in the delayed period (p=0.0002). Normalization of vegetative status was observed in 38% of patients with stage II CCI, and in 60% of cases there was a decrease in the severity of vegetative dystonia syndrome (p=0.0001). Picamilon therapy has high efficacy in assessing clinical outcomes (100%), good tolerability in 98% of patients and is characterized by a favorable safety profile (in 92% of patients). Picamilon significantly affects the parameters of cerebral hemodynamics: increases the linear velocity of blood flow, reduces the thickness of the intima-media complex and the resistance index. It affects markers of NO metabolism and endothelial function: significantly reduces elevated levels of ADMA and ADMA/MMA and (ADMA+SDMA)/MMA ratios. The use of Picamilon is effective in patients with stage II CCI in the form of step therapy contributes to a significant regression of neurological deficit, cognitive impairment, improvement of sleep quality and autonomic function; improves vascular endothelial function, reduces the risk of cardiovascular complications. Picamilon is a pathogenetic therapy agent that prevents the progression of CCI.

Synergistic effects of neuroendoscopic minimally invasive surgery with mannitol and furosemide in managing hypertensive intracerebral hemorrhage

This study aimed to assess the therapeutic efficacy of neuroendoscopic minimally invasive surgery combined with mannitol and furosemide for treating hypertensive intracerebral hemorrhage. We retrospectively analyzed clinical data from 200 patients with hypertensive intracerebral hemorrhage treated at our hospital between July 2020 and July 2022. The patients were categorized into either the experimental group (undergoing neuroendoscopic minimally invasive surgery combined with mannitol and furosemide) or the control group (undergoing neuroendoscopic minimally invasive surgery alone). Then, we compared the efficacy and impact on patients between the two groups. After treatment, the experimental group exhibited a smaller edema area compared to the control group and a reduced hematoma volume (p &lt; 0.001). The total effective rate was significantly higher in the experimental group compared to the control group (p &lt; 0.05). At 7 days post-treatment, patients in the experimental group demonstrated a significantly lower National Institutes of Health Stroke Scale (NIHSS) score compared to the control group (p &lt; 0.001). Additionally, 3 and 7 days after treatment, levels of lipid peroxidation (LPO), neuron-specific enolase (NSE), and S-100β were significantly lower in the experimental group compared to the control group (p &lt; 0.001). Similarly, carotid total blood flow volume (Q) and blood flow velocity (V) were significantly higher in the experimental group at 3 and 7 days post-treatment, with lower peripheral resistance (R) compared to the control group (p &lt; 0.001). The incidence rate of complications was significantly lower in the experimental group compared to the control group (p &lt; 0.05). The integration of neuroendoscopic minimally invasive surgery with mannitol and furosemide administration demonstrates potential in alleviating brain edema, reducing related cytokine levels, facilitating neurological function recovery, and improving cerebral hemodynamic parameters in hypertensive intracerebral hemorrhage patients. These findings merit clinical promotion and application.

HEMODYNAMIC PARAMETERS OF EXTRACRANIAL CEREBRAL ARTERIES AND HEART IN PATIENTS WITH OCCLUSION OF THE INTERNAL CAROTID ARTERY DURING VASCULAR SURGERY

HighlightsWe have analyzed the parameters of cerebral hemodynamics and left ventricular functional capacity in patients with occlusion and stenosis of the contralateral internal carotid artery during vascular surgery. Considering the importance of the left ventricular functional capacity and treatment options to ensure the stability of cerebral circulation in patients with occlusion and hemodynamically significant stenosis of the contralateral carotid artery, its detailed study at all stages of vascular surgery remains necessary. AbstractAim. To study cerebral hemodynamics and left ventricular functional capacity in patients with occlusion and stenosis of the contralateral internal carotid artery (ICA) to optimize treatment at the preoperative phase.Methods. The study compared the hemodynamic parameters of the blood flow of the ICA, vertebral arteries and left ventricular functional capacity in patients with ICA occlusion and contralateral ICA stenosis, which formed the 1 group (12 patients), and patients with unilateral hemodynamically significant stenosis, which formed the 2 group (52 patients). The blood flow in the extracranial portions of the major arteries of the head and heart was assessed using ultrasound, and the arterial vascular system and brain structure was assessed using MRI and MRA.Results. Before surgery, statistically significant differences in velocity parameters in the vertebral arteries on the occlusion side were found; on the contralateral occlusion side, velocity parameters in ICA were significantly different from the corresponding indicators in the group with unilateral stenosis; after surgery, statistically significant differences were found in the common carotid and vertebral arteries on the occlusion side; on the contralateral occlusion side, differences in velocity parameters in the common carotid, internal, and vertebral arteries were revealed in comparison with the group with unilateral stenosis. Of the indicators of the left ventricular functional capacity, only left ventricular ejection fraction differed significantly when comparing the group of patients with occlusion and stenosis of ICA and the group of patients with unilateral stenosis. Moreover, when evaluating pre- and postoperative outcomes in the group of patients with occlusion, significant differences were obtained only regarding the vertebral artery on the side of occlusion – the peak systolic blood flow velocity and the volumetric blood flow velocity significantly decreased. There were no significant differences between the common carotid, internal carotid arteries on the contralateral occlusion side, and middle cerebral arteries.Conclusion. Carrying out a comprehensive ultrasound examination of the main arteries of the head in combination with magnetic resonance imaging of the brain is a reliable and adequate way to assess cerebral hemodynamics, changes in the vascular bed and structure of the brain. Given the extreme importance of the left ventricular functional capacity to ensure the stability of cerebral circulation in patients with occlusion of the internal carotid artery and contralateral hemodynamically significant stenosis, its detailed study before carotid endarterectomy is necessary to adjust therapeutic measures.

Changes in cerebral hemodynamic parameters for patients with encephalopathies of different genesis

Mental function impairment is a common sign of encephalopathies, which various factors, including neurological disorders and cerebral hemodynamics, can cause.The purpose of the study was to establish changes in cerebral hemodynamic parameters in patients with encephalopathies of various origins.Material and methods. 520 patients with chronic traumatic encephalopathy (CTE, n=145), vascular encephalopathy in chronic brain ischemia (CVE, n=145), chronic alcoholic encephalopathy (CAE, n=102) and post-infectious encephalopathy (PIE, n=128) were examined. The patients were receiving inpatient treatment on the basis of the communal non-profit enterprise "Ternopil Regional Clinical Psychoneurological Hospital" during the period of 2021-2022. The cerebral blood flow was assessed using transcranial doppler scanning of intracranial and extracranial brachiocephalic vessels on a Philips HDI device.Research results. The most frequent disorders of cerebral hemodynamics in patients with CTE are the following: insufficient blood flow (44.83%), angiospasm (44.14%) and stenosis (40.69%); in patients with CVE – stenosis (67.59%), insufficient blood flow (66.21%) and venous stasis (64.83%); in patients with CAE – insufficient blood flow (32.35%), angiospasm (31.37%) and venous stasis (30.39%); in patients with PIE - angiospasm (45.31%), blood flow insufficiency (37.50%) and vertebro-basilar insufficiency (30.47%). Comparing the parameters of cerebral hemodynamics in patients with encephalopathies of various genesis, it was established that angiospasm in patients with CVE was recorded more often (by 23.11%) than in patients with CAE. A similar trend was noted in patients with CTE and PIE relative to the CAE group. The frequency of registration of blood flow insufficiency in patients with CVE probably exceeded the data of groups of CTE, CAE, and PIE (by 21.38, 33.86, and 28.71%, respectively). At the same time, the presence of changes within two distribution zones - carotid cerebral and vertebral-basilar in patients with CVE probably exceeded the data of the CAE and PIE groups. Regarding the comparison of the characteristics of stenoses, the frequency of detection of this phenomenon in patients with CTE probably exceeded the data of the CTE, CAE, and PIE groups (by 26.90, 53.86, and 64.46%, respectively). At the same time, the proportion of patients with significant stenosis in the CTE group probably exceeded the data of the CVE, CAE and PIE groups. The highest frequency of registration of venous stasis was established in patients with CTE (64.83%), which probably exceeded the data of the CTE, CAE and PIE groups. Vertebro-basilar insufficiency was not detected in patients with CAE, and in the PIE group its frequency of registration was 14.61% higher than the data of the CVE group and 18.06% higher than the data of the CTE group.Conclusions. The obtained results indicate the heterogeneity and polymorphism of the parameters of cerebral hemodynamics in patients with encephalopathies of various genesis, which requires further research to find possible relationships between them and cognitive dysfunction.

ACE and AT2R1 gene polymorphism in patients with chronic vascular encephalopathy: association with neuroimaging changes and cognitive functioning

Background. Given the synergistic effect of the ACE and AT2R1 genes and their impact on the maintenance of homeostatic processes, the aim of our research was to identify the associations of the studied polymorphic variants of the ACE and AT2R1 genes with neuroimaging changes, data from arterial duplex ultrasound and cognitive functioning in patients with chronic vascular encephalopathy (CVE). Materials and methods. A retrospective analysis of 145 medical records of patients with CVE was conducted, of which 18 patients underwent a molecular genetic study. The control group consisted of 12 people representative in terms of age and gender. Neuroimaging was performed using multislice computed tomography or magnetic resonance imaging. The state of cerebral blood flow was studied using transcranial duplex ultrasound of intracranial and extracranial vessels. The cognitive functioning was tested using the Montreal Cognitive Assessment. Results. When analyzing the associations of polymorphic I/D variants of the ACE gene and A1166C of the AT2R1 gene with neuroimaging changes and parameters of cerebral hemodynamics in CVE among carriers of I and D alleles of the ACE gene, a probable relationship was found between their frequency distribution and the presence/absence of gliosis phenomena (62.69 % of D allele carriers were diagnosed with gliosis, p &lt; 0.05); a probable relationship between the frequency distribution of the D/D genotype of the ACE gene and the presence of angiospasm (in 72.73 % of patients), insufficiency of blood flow in the carotid system (72.73 % of cases) and vertebrobasilar insufficiency (in 36.36 % of people). When evaluating the dependence of cognitive functions based on the Montreal Cognitive Assessment score in patients with CVE on the polymorphic I/D variants of the ACE gene and A1166C of the AT2R1 gene, probable changes were revealed in the frequency distribution of genotypes and alleles of the polymorphic I/D variant of the ACE gene (χ2 = 11.33; p = 0.023), while all carriers of the D/D genotype have impaired cognitive functioning (moderate in 36.36 % and mild in 63.64 % of cases), which also corresponds to the frequency of the D allele distribution in this cohort of patients (29.63 % of people have a moderate cognitive impairment and 70.37 % — a mild cognitive impairment, p = 0.013). Conclusions. The study results indicate that the ACE gene may be involved in the development of neuroimaging changes and cognitive decline in CVE.

How I do it: direct pressure measurement in moyamoya bypass.

The direct quantitative measurement of donor and recipient pressures in patients with moyamoya vasculopathy (MMV) during superficial temporal artery-middle cerebral artery (STA-MCA) bypass surgery has yet to be reported in academic literature. Using a wireless pressure wire, we describe our approach to measuring seven pressure parameters in MMV patients step-by-step. Direct intraluminal pressure measurement of donor and recipient arteries provides a practical and accurate means to quantify cerebral hemodynamic parameters in MMV patients, enhancing understanding of individualized hemodynamic changes pre- and post-surgery.

Higher critical closing pressure is independently associated with enlarged basal ganglia perivascular spaces.

This study aimed to explore the association between cerebral hemodynamic parameters focused on the critical closing pressure (CCP) and enlarged perivascular spaces (EPVS). Cerebral blood velocity in the middle cerebral artery (MCAv) and non-invasive continuous blood pressure (NIBP) were measured using a transcranial Doppler (TCD) and Finometer, followed by the calculation of cerebral hemodynamic parameters including CCP, resistance area product (RAP), pulsatility index (PI), and pulse pressure (PP). EPVS were graded separately in the basal ganglia (BG) and centrum semiovale (CSO), using a visual semiquantitative ordinal scale. Patients with EPVS >10 were classified into the severe BG-EPVS group and severe CSO-EPVS group, and the remainder into the mild BG-EPVS group and the mild CSO-EPVS group. Spearman's correlation and binary logistic regression analysis were performed to analyze the relationship between hemodynamic parameters and BG-EPVS and CSO-EPVS, respectively. Overall, 107 patients were enrolled. The severe BG-EPVS group had higher CCP, mean arterial blood pressure (MABP), systolic blood pressure (SBP), and diastolic blood pressure (DBP) than that in the mild BG-EPVS group (p < 0.05). There was no statistical difference in hemodynamic parameters between the severe CSO-EPVS group and the mild CSO-EPVS group. Spearman's correlation analysis showed that CCP was positively associated with BG-EPVS (rho = 0.331, p < 0.001) and CSO-EPVS (rho = 0.154, p = 0.044). The binary logistic regression analysis showed that CCP was independently associated with severe BG-EPVS (p < 0.05) and not with CSO-EPVS (p > 0.05) after adjusting for confounders. CCP representing cerebrovascular tension was independently associated with BG-EPVS.

The efficacy of STA-MCA double anastomosis comparing to single anastomosis in chronic internal carotid artery occlusion patients

ObjectiveTo investigate the efficacy of STA-MCA double-anastomosis and single-anastomosis in patients with cerebral hypoperfusion caused by chronic internal carotid artery occlusion(CICAO). MethodsIn this retrospective study, data were collected from 19 patients with CICAO who underwent STA-MCA anastomosis at our hospital between January 2016 and January 2022, and they were divided into single anastomosis group and double anastomosis group according to the surgical method. The study collected general clinical data from both groups, including age, sex, lipid levels, blood pressure, glucose levels, smoking and alcohol consumption. Additionally, pre- and postoperative neurological function, cerebral hemodynamic parameters, and postoperative ischemic events were also recorded. By combining our study findings with the existing literature, a comparative analysis of the efficacy of single- and double-anastomosis in patients with CICAO was conducted. ResultsPrior to surgical treatment，there were no statistically significant differences in cerebral hemodynamic parameters, including rob (0.65 ± 0.09 VS. 0.62 ± 0.04), rut (1.73 ± 0.40 VS. 1.99 ± 0.53), and rTMax (2.02 ± 0.49 VS. 1.72 ± 0.46), as well as neurofunctional scores, including modified Rankin Scale (MRS) (2.8 ± 1.03 VS. 2.4 ± 0.88) and National Institutes of Health Stroke Scale (NIHSS) (9.1 ± 5.08 VS. 8.3 ± 4.09) between the two groups. After operation, rCBF (single: 0.65 ± 0.09 VS.0.84 ± 0.08, p = 0.007; double: 0.62 ± 0.04 VS.1.08 ± 0.20, p = 0.001) were significantly increased in both groups, but the rMTT (1.99 ± 0.53 VS.1.27 ± 0.42, p = 0.0447) and rTMax (1.72 ± 0.46 VS.1.16 ± 0.16, p = 0.038) showed significant differences postoperatively only in the double-anastomosis group. The MRS (single: 1.8 ± 1.23, double: 1.7 ± 0.9) in both groups and the NIHSS (7.2 ± 5.11) in single-anastomosis group were not improved after surgery, while the NIHSS (8.3 ± 4.09 VS.4.4 ± 3.08, p = 0.037) in double-anastomosis group was improve significantly. In summary, the double-anastomosis group showed better improvement in rCBF and NIHSS scores compared to the single-anastomosis group.(ΔrCBF: 0.19±0.09 VS. 0.45±0.18, p=0.02, ΔNIHSS: 1.9±0.56 VS. 4±1.73, p=0.002). The cases were followed up for 20.3 ± 18.6 months, and there were no ischemic events in either group during the follow-up period. ConclusionSTA-MCA revascularization can improve CBF in patients with hypoperfusion caused by CICAO, and prevent the reoccurrence of ischemic stroke effectively. Compared with single-anastomosis, double-anastomosis can provide more CBF and improve neurologic dysfunction.