Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease

Hartkamp, Nolan S; Petersen, Esben T; Chappell, Michael A; Okell, Thomas W; Uyttenboogaart, Maarten; Zeebregts, Clark J; Bokkers, Reinoud PH

Abstract

Collateral blood flow plays a pivotal role in steno-occlusive internal carotid artery (ICA) disease to prevent irreversible ischaemic damage. Our aim was to investigate the effect of carotid artery disease upon cerebral perfusion and cerebrovascular reactivity and whether haemodynamic impairment is influenced at brain tissue level by the existence of primary and/or secondary collateral. Eighty-eight patients with steno-occlusive ICA disease and 29 healthy controls underwent MR examination. The presence of collaterals was determined with time-of-flight, two-dimensional phase contrast MRA and territorial arterial spin labeling (ASL) imaging. Cerebral blood flow and cerebrovascular reactivity were assessed with ASL before and after acetazolamide. Cerebral haemodynamics were normal in asymptomatic ICA stenosis patients, as opposed to patients with ICA occlusion, in whom the haemodynamics in both hemispheres were compromised. Haemodynamic impairment in the affected brain region was always present in symptomatic patients. The degree of collateral blood flow was inversely correlated with haemodynamic impairment. Recruitment of secondary collaterals only occurred in symptomatic ICA occlusion patients. In conclusion, both CBF and cerebrovascular reactivity were found to be reduced in symptomatic patients with steno-occlusive ICA disease. The presence of collateral flow is associated with further haemodynamic impairment. Recruitment of secondary collaterals is associated with severe haemodynamic impairment.

Citation

Hartkamp, N. S., Petersen, E. T., Chappell, M. A., Okell, T. W., Uyttenboogaart, M., Zeebregts, C. J., & Bokkers, R. P. (2018). Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease. Journal of Cerebral Blood Flow and Metabolism, 38(11), 2021-2032. https://doi.org/10.1177/0271678x17724027

• Journal Article Type: Article
• Acceptance Date: Jun 10, 2017
• Online Publication Date: Aug 4, 2017
• Publication Date: 2018-11
• Deposit Date: Sep 8, 2020
• Publicly Available Date: Sep 25, 2020
• Journal: Journal of Cerebral Blood Flow & Metabolism
• Print ISSN: 0271-678X
• Electronic ISSN: 1559-7016
• Publisher: SAGE Publications
• Peer Reviewed: Peer Reviewed
• Volume: 38
• Issue: 11
• Pages: 2021-2032
• DOI: https://doi.org/10.1177/0271678x17724027
• Keywords: Neurology; Clinical Neurology; Cardiology and Cardiovascular Medicine
• Public URL: https://nottingham-repository.worktribe.com/output/4889284
• Publisher URL: https://journals.sagepub.com/doi/10.1177/0271678X17724027
• Additional Information: Hartkamp NS, Petersen ET, Chappell MA, et al. Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease. Journal of Cerebral Blood Flow & Metabolism. 2018;38(11):2021-2032. doi:10.1177/0271678X17724027