Document Detail

Increased cerebral arterial pulsatility in patients with leukoaraiosis: arterial stiffness enhances transmission of aortic pulsatility.
MedLine Citation:
PMID:  22923446     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND PURPOSE: Arterial stiffening reduces damping of the arterial waveform and hence increases pulsatility of cerebral blood flow, potentially damaging small vessels. In the absence of previous studies in patients with recent transient ischemic attack or stroke, we determined the associations between leukoaraiosis and aortic and middle cerebral artery stiffness and pulsatility.
METHODS: Patients were recruited from the Oxford Vascular Study within 6 weeks of a transient ischemic attack or minor stroke. Leukoaraiosis was categorized on MRI by 2 independent observers with the Fazekas and age-related white matter change scales. Middle cerebral artery (MCA) stiffness (transit time) and pulsatility (Gosling's index: MCA-PI) were measured with transcranial ultrasound and aortic pulse wave velocity and aortic systolic, diastolic, and pulse pressure with applanation tonometry (Sphygmocor).
RESULTS: In 100 patients, MCA-PI was significantly greater in patients with leukoaraiosis (0.91 versus 0.73, P<0.0001). Severity of leukoaraiosis was associated with MCA-PI and aortic pulse wave velocity (Fazekas: χ(2)=0.39, MCA-PI P=0.01, aortic pulse wave velocity P=0.06; age-related white matter change: χ(2)=0.38, MCA-PI P=0.015; aortic pulse wave velocity P=0.026) for periventricular and deep white matter lesions independent of aortic systolic blood pressure, diastolic blood pressure, and pulse pressure and MCA transit time with MCA-PI independent of age. In a multivariate model (r(2)=0.68, P<0.0001), MCA-PI was independently associated with aortic pulse wave velocity (P=0.016) and aortic pulse pressure (P<0.0001) and inversely associated with aortic diastolic blood pressure (P<0.0001) and MCA transit time (P=0.001).
CONCLUSIONS: MCA pulsatility was the strongest physiological correlate of leukoaraiosis, independent of age, and was dependent on aortic diastolic blood pressure and pulse pressure and aortic and MCA stiffness, supporting the hypothesis that large artery stiffening results in increased arterial pulsatility with transmission to the cerebral small vessels resulting in leukoaraiosis.
Alastair J S Webb; Michela Simoni; Sara Mazzucco; Wilhelm Kuker; Ursula Schulz; Peter M Rothwell
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Publication Detail:
Type:  Journal Article; Research Support, Non-U.S. Gov't     Date:  2012-08-23
Journal Detail:
Title:  Stroke; a journal of cerebral circulation     Volume:  43     ISSN:  1524-4628     ISO Abbreviation:  Stroke     Publication Date:  2012 Oct 
Date Detail:
Created Date:  2012-09-25     Completed Date:  2013-01-17     Revised Date:  2014-02-24    
Medline Journal Info:
Nlm Unique ID:  0235266     Medline TA:  Stroke     Country:  United States    
Other Details:
Languages:  eng     Pagination:  2631-6     Citation Subset:  IM    
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MeSH Terms
Aged, 80 and over
Aorta / physiopathology*,  ultrasonography
Arterial Pressure / physiology
Blood Flow Velocity / physiology
Blood Pressure / physiology
Cerebrovascular Circulation / physiology
Cross-Sectional Studies
Ischemic Attack, Transient / physiopathology*
Leukoaraiosis / physiopathology*
Middle Aged
Middle Cerebral Artery / physiopathology*,  ultrasonography
Pulse Wave Analysis*
Stroke / physiopathology*
Ultrasonography, Doppler, Transcranial
Vascular Stiffness / physiology*
Grant Support
095626//Wellcome Trust; G0500987//Medical Research Council; G0701128//Medical Research Council; G1000372//Medical Research Council; OSRP2/1006//The Dunhill Medical Trust; RP-PG-0606-1146//Department of Health; //Medical Research Council; //Wellcome Trust

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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