Stroke. 2011 Jun;42(6):1631-7. doi: 10.1161/STROKEAHA.110.608521. Epub 2011 Apr 14.
Chronic deficiencies in regional blood flow lead to cerebral cortical thinning without evidence of gross tissue loss at the same time as potentially negatively impacting on neurological and cognitive performance. This is most pronounced in patients with severe occlusive cerebrovascular disease in whom affected brain areas exhibit "steal physiology," a paradoxical reduction of cerebral blood flow in response to a global vasodilatory stimulus intended to increase blood flow. We tested whether surgical brain revascularization that eliminates steal physiology can reverse cortical thinning.
We identified 29 patients from our database who had undergone brain revascularization with pre- and postoperative studies of cerebrovascular reactivity using blood oxygen(ation) level-dependent MRI and whose preoperative study exhibited steal physiology without MRI-evident structural abnormalities. Cortical thickness in regions corresponding to steal physiology, and where applicable corresponding areas in the normal hemisphere, were measured using Freesurfer software.
At an average of 11 months after surgery, cortical thickness increased in every successfully revascularized hemisphere (n=30). Mean cortical thickness in the revascularized regions increased by 5.1% (from 2.40 ± 0.03 to 2.53 ± 0.03; P<0.0001).
Successful regional revascularization and reversal of steal physiology is followed by restoration of cortical thickness.
慢性区域性血流不足可导致皮质变薄，而无明显的组织丢失，但可能对神经和认知功能产生负面影响。这在严重的闭塞性脑血管病患者中最为明显，这些患者受影响的大脑区域表现出“盗血现象”，即对旨在增加血流量的全身性血管扩张刺激反应出现脑血流减少的反常现象。我们检测了是否可通过消除盗血现象的脑血运重建来逆转皮质变薄。
我们从数据库中确定了 29 名患者，这些患者接受了脑血运重建，术前和术后使用血氧水平依赖性 MRI 检测脑血管反应性，且术前研究显示存在盗血现象，但无 MRI 可见的结构异常。使用 Freesurfer 软件测量与盗血现象对应的区域（如果适用，还包括正常半球对应的区域）的皮质厚度。
在术后平均 11 个月时，每侧成功重建血运的半球（n=30）的皮质厚度均增加。在血运重建区域，皮质厚度平均增加 5.1%（从 2.40 ± 0.03 增加到 2.53 ± 0.03；P<0.0001）。
区域性血运重建成功和盗血现象逆转后，皮质厚度得以恢复。
