Long-term changes in cerebrovascular reactivity following EC-IC bypass for intracranial steno-occlusive disease. (August 2018)

• Record Type: Journal Article
• Authors: Rosen, Casey; McKetton, Larissa; Russell, Jeremy; Sam, Kevin; Poublanc, Julien; Crawley, Adrian; Han, Jay S.; Sobczyk, Olivia; Duffin, James; Mandell, Danny M.; Tymianski, Michael; Fisher, Joseph A.; Mikulis, David J.; Venkatraghavan, Lashmi
• Is Part Of: Journal of clinical neuroscience. Volume 54(2018)
• Page Start: 77
• Page End: 82
• Publication Date: 2018-08
• Subjects: Extracranial-intracranial bypass -- Steno occlusive disease -- Cerebrovascular reactivity -- Blood-oxygen-level dependent magnetic resonance imaging; Brain -- Surgery -- Periodicals; Neurosciences -- Periodicals; Nervous system -- Surgery -- Periodicals; Brain -- surgery -- Periodicals; Neurosurgical Procedures -- Periodicals; Neurosciences -- Periodicals; Electronic journals; 616.8
• DOI: 10.1016/j.jocn.2018.06.009
• Languages: English
• ISSNs: 0967-5868

Abstract

Highlights: This study investigated the long-term changes in the cerebral hemodynamics. Cerebral revascularization has a variable effect on the cerebral hemodynamics. Cerebral revascularization does not eliminate the risk of acute and chronic cerebral ischemia. Abstract: The purpose of this retrospective observational study is to investigate the long-term changes in cerebrovascular reactivity (CVR) as a measure of cerebral hemodynamics in patients with intracranial steno-occlusive disease (IC-SOD) after they have undergone an Extracranial–intracranial (EC-IC) bypass. Twenty-six patients suffering from IC-SOD were selected from our CVR database. Nineteen patients underwent unilateral and 7 underwent bilateral revascularization. CVR measurements were done using BOLD-MRI and precisely controlled CO2 and expressed as ΔBOLD (%)/Δ PET CO2 (mmHg). Trends in CVR over time were compared in both vascularized and non-vascularized hemispheres. Repeated measures analysis of variance with Greenhouse-Geisser correction was used to determine CVR changes within the grey matter MCA for longitudinal assessments. Overall, re-vascularized hemisphere showed a significant increase in CVR at the first follow-up, followed by a slight decrease at the second follow-up that significantly increased compared to the pre-bypass. However, the changes in the postoperative CVR were quite variable across the patients. Similar variability was seen in subsequent follow-ups, with a slight overall decline in the long term CVR as compared with first post-operative CVR. Our study demonstrates that EC-IC bypass has a beneficial long-term effect on cerebral hemodynamics and this effect varies between patients probably due to the variability in the underlying vascular pattern receiving the bypass. Hence, in the postoperative follow-up of patients routine functional imaging to monitor cerebral hemodynamics may be useful as the risk of stroke and cognitive decline remain present with impaired CVR.