Progressive Cortical Neuronal Damage and Chronic Hemodynamic Impairment in Atherosclerotic Major Cerebral Artery Disease

BACKGROUND AND PURPOSE—Cross-sectional studies suggest that chronic hemodynamic impairment may cause selective cortical neuronal damage in patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease. The purpose of this longitudinal study was to determine whethe...

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Bibliographic Details
Published in:Stroke (1970) 2016-06, Vol.47 (6), p.1534-1541
Main Authors: Yamauchi, Hiroshi, Kagawa, Shinya, Kishibe, Yoshihiko, Takahashi, Masaaki, Higashi, Tatsuya
Format: Article
Language:English
Subjects:
Aged
Carotid Artery Diseases - diagnostic imaging
Carotid Artery Diseases - pathology
Cerebral Arterial Diseases - diagnostic imaging
Cerebral Arterial Diseases - pathology
Cerebral Cortex - diagnostic imaging
Cerebral Cortex - metabolism
Cerebral Cortex - pathology
Cerebrovascular Circulation
Cross-Sectional Studies
Female
Flumazenil
Hemodynamics
Humans
Infarction, Middle Cerebral Artery - diagnostic imaging
Infarction, Middle Cerebral Artery - drug therapy
Intracranial Arteriosclerosis - diagnostic imaging
Intracranial Arteriosclerosis - pathology
Longitudinal Studies
Male
Middle Aged
Neurons - pathology
Positron-Emission Tomography
Prognosis
Radiopharmaceuticals
Receptors, GABA-A - drug effects
Receptors, GABA-A - metabolism
Risk Factors
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Summary:BACKGROUND AND PURPOSE—Cross-sectional studies suggest that chronic hemodynamic impairment may cause selective cortical neuronal damage in patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease. The purpose of this longitudinal study was to determine whether the progression of cortical neuronal damage, evaluated as a decrease in central benzodiazepine receptors (BZRs), is associated with hemodynamic impairment at baseline or hemodynamic deterioration during follow-up. METHODS—We evaluated the distribution of BZRs twice using positron emission tomography and C-flumazenil over time in 80 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery occlusive disease that had no ischemic episodes during follow-up. Using 3D stereotactic surface projections, we quantified abnormal decreases in the BZRs in the cerebral cortex within the middle cerebral artery distribution and correlated changes in the BZR index with the mean hemispheric values of hemodynamic parameters obtained from O gas positron emission tomography. RESULTS—In the hemisphere affected by arterial disease, the BZR index in 40 patients (50%) was increased during follow-up (mean 26±20 months). In multivariable logistic regression analyses, increases in the BZR index were associated with the decreased cerebral blood flow at baseline and an increased oxygen extraction fraction during follow-up. Increases in the oxygen extraction fraction during follow-up were associated with a lack of statin use. CONCLUSIONS—In patients with atherosclerotic internal carotid artery or middle cerebral artery disease, the progression of cortical neuronal damage was associated with hemodynamic impairment at baseline and hemodynamic deterioration during follow-up. Statin use may be beneficial against hemodynamic deterioration and therefore neuroprotective.
ISSN:0039-2499
1524-4628
DOI:10.1161/STROKEAHA.116.013093