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

Nolan S. Hartkamp, Esben T. Petersen, Michael A. Chappell, Thomas W. Okell, Maarten Uyttenboogaart, Clark J. Zeebregts, Reinoud P.H. Bokkers*

*Corresponding author for this work

Research output: Contribution to journalJournal articleResearchpeer-review

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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.

Original languageEnglish
JournalJournal of Cerebral Blood Flow and Metabolism
Volume38
Issue number11
Pages (from-to)2021-2032
ISSN0271-678X
DOIs
Publication statusPublished - 1 Nov 2018

Keywords

  • Carotid artery
  • Cerebral hemodynamics
  • MRI
  • MRI angiography
  • Perfusion-weighted MRI
  • Stroke

Cite this

Hartkamp, N. S., Petersen, E. T., Chappell, M. A., Okell, T. W., Uyttenboogaart, M., Zeebregts, C. J., & Bokkers, R. P. H. (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
Hartkamp, Nolan S. ; Petersen, Esben T. ; Chappell, Michael A. ; Okell, Thomas W. ; Uyttenboogaart, Maarten ; Zeebregts, Clark J. ; Bokkers, Reinoud P.H. / Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease. In: Journal of Cerebral Blood Flow and Metabolism. 2018 ; Vol. 38, No. 11. pp. 2021-2032.
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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.",
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author = "Hartkamp, {Nolan S.} and Petersen, {Esben T.} and Chappell, {Michael A.} and Okell, {Thomas W.} and Maarten Uyttenboogaart and Zeebregts, {Clark J.} and Bokkers, {Reinoud P.H.}",
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Hartkamp, NS, Petersen, ET, Chappell, MA, Okell, TW, Uyttenboogaart, M, Zeebregts, CJ & Bokkers, RPH 2018, 'Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease', Journal of Cerebral Blood Flow and Metabolism, vol. 38, no. 11, pp. 2021-2032. https://doi.org/10.1177/0271678X17724027

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 P.H.

In: Journal of Cerebral Blood Flow and Metabolism, Vol. 38, No. 11, 01.11.2018, p. 2021-2032.

Research output: Contribution to journalJournal articleResearchpeer-review

TY - JOUR

T1 - Relationship between haemodynamic impairment and collateral blood flow in carotid artery disease

AU - Hartkamp, Nolan S.

AU - Petersen, Esben T.

AU - Chappell, Michael A.

AU - Okell, Thomas W.

AU - Uyttenboogaart, Maarten

AU - Zeebregts, Clark J.

AU - Bokkers, Reinoud P.H.

PY - 2018/11/1

Y1 - 2018/11/1

N2 - 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.

AB - 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.

KW - Carotid artery

KW - Cerebral hemodynamics

KW - MRI

KW - MRI angiography

KW - Perfusion-weighted MRI

KW - Stroke

U2 - 10.1177/0271678X17724027

DO - 10.1177/0271678X17724027

M3 - Journal article

VL - 38

SP - 2021

EP - 2032

JO - Journal of Cerebral Blood Flow and Metabolism

JF - Journal of Cerebral Blood Flow and Metabolism

SN - 0271-678X

IS - 11

ER -