Ortega-Gutierrez Santiago, Samaniego Edgar A, Huang Amy, Masurkar Arjun, Zheng-Lin Binbin, Derdeyn Colin P, Hasan David, Marshall Randolph, Petersen Nils
Stroke Division, Neurointerventional Surgery Section, Departments of Neurology, Neurosurgery and Radiology University of Iowa Hospitals and Clinics, Iowa, IA.
Division of Neurocritical Care and Emergency Neurology, Department of Neurology, Yale University School of Medicine, New Haven, CT.
J Vasc Interv Neurol. 2018 Jun;10(1):1-6.
Severe intracranial stenosis might lead to acute cerebral ischemia. It is imperative to better assess patients who may benefit from immediate reperfusion and blood pressure management to prevent injury to peri-infarct tissue.
We assessed cerebral autoregulation using static and dynamic methods in an 81-year-old woman suffering acute cerebral ischemia from severe intracranial stenosis in the petrous segment of the left internal carotid artery (LICA).
Static cerebral autoregulation, which is evaluated by magnetic resonance imaging and magnetic resonance perfusion studies showed a progression of infarcts and a large perfusion-diffusion mismatch in the entire LICA territory between the second and third days after onset despite maximized medical therapy. Dynamic methods, including transfer function analysis and mean velocity index, demonstrated an increasingly impaired dynamic cerebral autoregulation (DCA) on the affected side between these days. Revascularization through acute intracranial stenting resulted in improved perfusion in the LICA territory and normalization of both dynamic and static cerebral autoregulation.
Thus, DCA, a noninvasive bedside method, may be useful in helping to identify and select patients with large-vessel flow-failure syndromes that would benefit from immediate revascularization of intracranial atherosclerotic disease.
严重颅内狭窄可能导致急性脑缺血。必须更好地评估那些可能从即刻再灌注和血压管理中获益的患者，以防止梗死周围组织受损。
我们对一名81岁女性进行了静态和动态方法的脑自动调节评估，该女性因左侧颈内动脉岩骨段严重颅内狭窄而患有急性脑缺血。
通过磁共振成像和磁共振灌注研究评估的静态脑自动调节显示，尽管采取了最大程度的药物治疗，但在发病后第二天至第三天之间，整个左侧颈内动脉区域梗死进展且灌注-扩散不匹配较大。包括传递函数分析和平均速度指数在内的动态方法表明，在这几天内患侧的动态脑自动调节（DCA）逐渐受损。通过急性颅内支架置入术进行血管重建可改善左侧颈内动脉区域的灌注，并使动态和静态脑自动调节恢复正常。
因此，DCA作为一种非侵入性床边方法，可能有助于识别和选择那些将从颅内动脉粥样硬化疾病的即刻血管重建中获益的大血管血流衰竭综合征患者。
