| Partial aortic occlusion and cerebral venous steal: venous effects of arterial manipulation in acute stroke. | |
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MedLine Citation:
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PMID: 21441149 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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Acute ischemic stroke therapy emphasizes early arterial clot lysis or removal. Partial aortic occlusion has recently emerged as an alternative hemodynamic approach to augment cerebral perfusion in acute ischemic stroke. The exact mechanism of cerebral flow augmentation with partial aortic occlusion remains unclear and may involve more than simple diversion of arterial blood flow from the lower body to cerebral collateral circulation. The cerebral venous steal hypothesis suggests that even a small increase in tissue pressure in the ischemic area will divert blood flow to surrounding regions with lesser tissue pressures. This may cause no-reflow (absence of flow after restoration of arterial patency) in the ischemic core and "luxury perfusion" in the surrounding regions. Such maldistribution may be reversed with increased venous pressure titrated to avoid changes in intracranial pressure. We propose that partial aortic occlusion enhances perfusion in the brain by offsetting cerebral venous steal. Partial aortic occlusion redistributes blood volume into the upper part of the body, manifested by an increase in central venous pressure. Increased venous pressure recruits the collapsed vascular network and, by eliminating cerebral venous steal, corrects perifocal perfusion maldistribution analogous to positive end-expiratory pressure recruitment of collapsed airways to decrease ventilation/perfusion mismatch in the lungs. |
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Authors:
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Osvaldas Pranevicius; Mindaugas Pranevicius; David S Liebeskind |
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Publication Detail:
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Type: Journal Article; Research Support, N.I.H., Extramural Date: 2011-03-24 |
Journal Detail:
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Title: Stroke; a journal of cerebral circulation Volume: 42 ISSN: 1524-4628 ISO Abbreviation: Stroke Publication Date: 2011 May |
Date Detail:
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Created Date: 2011-04-26 Completed Date: 2011-06-30 Revised Date: 2012-05-02 |
Medline Journal Info:
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Nlm Unique ID: 0235266 Medline TA: Stroke Country: United States |
Other Details:
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Languages: eng Pagination: 1478-81 Citation Subset: IM |
Affiliation:
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Department of Anesthesiology, New York Hospital Queens, Flushing, NY, USA. opranevicius@aol.com |
Export Citation:
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APA/MLA Format Download EndNote Download BibTex |
| MeSH Terms | |
Descriptor/Qualifier:
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Aorta
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physiopathology* Aortic Diseases / physiopathology* Blood Pressure / physiology Blood Volume / physiology Cerebral Veins / physiopathology* Humans Regional Blood Flow / physiology Stroke / physiopathology* |
| Grant Support | |
ID/Acronym/Agency:
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K23 NS054084/NS/NINDS NIH HHS; K23 NS054084-05/NS/NINDS NIH HHS; P50 NS044378/NS/NINDS NIH HHS |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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