Departments of Neurology and Neurosurgery, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Department of Neurology, Cedars-Sinai Medical Center, Los Angeles, CA, USA.
J Cereb Blood Flow Metab. 2021 Apr;41(4):693-706. doi: 10.1177/0271678X20972869. Epub 2020 Nov 19.
Adrenoceptor and calcium channel modulating medications are widely used in clinical practice for acute neurological and systemic conditions. It is generally assumed that the cerebrovascular effects of these drugs mirror that of their systemic effects - and this is reflected in how these medications are currently used in clinical practice. However, recent research suggests that there are distinct cerebrovascular-specific effects of these medications that are related to the unique characteristics of the cerebrovascular anatomy including the regional heterogeneity in density and distribution of adrenoceptor subtypes and calcium channels along the cerebrovasculature. In this review, we critically evaluate existing basic science and clinical research to discuss known and putative interactions between adrenoceptor and calcium channel modulating pharmacotherapies, the neurovascular unit, and cerebrovascular anatomy. In doing so, we provide a rationale for selecting vasoactive medications based on lesion location and lay a foundation for future investigations that will define neuroprotective paradigms of adrenoceptor and calcium channel modulating therapies to improve neurological outcomes in acute neurological and systemic disorders.
肾上腺素能受体和钙通道调节药物在临床实践中广泛用于治疗急性神经和全身疾病。一般认为这些药物对脑血管的作用与其对全身的作用相似，这反映在这些药物在临床实践中的应用方式上。然而，最近的研究表明，这些药物对脑血管有独特的作用，这与脑血管解剖的独特特征有关，包括沿脑血管分布的肾上腺素能受体亚型和钙通道的区域性异质性。在这篇综述中，我们批判性地评估了现有的基础科学和临床研究，以讨论已知和推测的肾上腺素能受体和钙通道调节药物、神经血管单元和脑血管解剖之间的相互作用。这样，我们为根据病变位置选择血管活性药物提供了一个合理的依据，并为未来的研究奠定了基础，这些研究将确定肾上腺素能受体和钙通道调节治疗的神经保护范例，以改善急性神经和全身疾病的神经学结果。
