Neurology Department, School of Medicine, Hospital das Clinicas, University of São Paulo, São Paulo, Brazil.
Department of Neurology, Hospital Nove de Julho, São Paulo, Brazil.
J Cereb Blood Flow Metab. 2022 Mar;42(3):430-453. doi: 10.1177/0271678X211045222. Epub 2021 Sep 13.
Acute stroke is associated with high morbidity and mortality. In the last decades, new therapies have been investigated with the aim of improving clinical outcomes in the acute phase post stroke onset. However, despite such advances, a large number of patients do not demonstrate improvement, furthermore, some unfortunately deteriorate. Thus, there is a need for additional treatments targeted to the individual patient. A potential therapeutic target is interventions to optimize cerebral perfusion guided by cerebral hemodynamic parameters such as dynamic cerebral autoregulation (dCA). This narrative led to the development of the INFOMATAS (Identifying New targets FOr Management And Therapy in Acute Stroke) project, designed to foster interventions directed towards understanding and improving hemodynamic aspects of the cerebral circulation in acute cerebrovascular disease states. This comprehensive review aims to summarize relevant studies on assessing dCA in patients suffering acute ischemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage. The review will provide to the reader the most consistent findings, the inconsistent findings which still need to be explored further and discuss the main limitations of these studies. This will allow for the creation of a research agenda for the use of bedside dCA information for prognostication and targeted perfusion interventions.
急性中风与高发病率和死亡率有关。在过去的几十年中,人们研究了新的治疗方法,以期改善中风发病后的急性期的临床结果。然而,尽管取得了这些进展,仍有大量患者没有得到改善,甚至有些患者不幸恶化。因此,需要针对个体患者的其他治疗方法。一个潜在的治疗靶点是干预措施,通过脑血流动力学参数(如动态脑自动调节)来优化脑灌注。这一叙述促成了 INFOMATAS(识别急性中风管理和治疗的新靶点)项目的发展,旨在促进针对急性脑血管疾病状态下脑循环血流动力学方面的理解和改善的干预措施。这篇全面的综述旨在总结评估急性缺血性中风、脑出血和蛛网膜下腔出血患者的 dCA 的相关研究。该综述将为读者提供最一致的发现、仍需要进一步探讨的不一致发现,并讨论这些研究的主要局限性。这将为使用床边 dCA 信息进行预后和靶向灌注干预措施创建一个研究议程。