Long-term hemodynamic changes and blood pressure in atherosclerotic major cerebral artery disease

• Published in: Journal of cerebral blood flow and metabolism Vol. 39; no. 2; pp. 324 - 331
• Main Authors: Yamauchi, Hiroshi, Kagawa, Shinya, Takahashi, Masaaki, Higashi, Tatsuya
• Format: Journal Article
• Language: English
• Published: London, England SAGE Publications 01.02.2019
• Subjects: Aged; Blood Pressure; Carotid Artery Diseases - diagnostic imaging; Carotid Artery Diseases - physiopathology; Cerebral Arterial Diseases - diagnostic imaging; Cerebral Arterial Diseases - physiopathology; Cerebrovascular Circulation; Female; Follow-Up Studies; Humans; Intracranial Arteriosclerosis - diagnostic imaging; Intracranial Arteriosclerosis - physiopathology; Male; Middle Aged; Original; Positron-Emission Tomography; Tomography, X-Ray Computed; positron-emission tomography; blood pressure; cerebral blood flow; Carotid artery disease; middle cerebral artery disease
• ISSN: 0271-678X; 1559-7016
• DOI: 10.1177/0271678X17727385

In patients with major cerebral artery disease, lower blood pressure might reduce blood flow in the collateral pathways, thereby impairing the growth of cerebral collaterals, inhibiting hemodynamic improvement. We evaluated the hemodynamic status twice using positron emission tomography and 15O-gas, over time, in 89 medically treated patients with atherosclerotic internal carotid artery or middle cerebral artery disease that had no ischemic episodes during follow-up (mean, 28 ± 23 months). Changes in the mean hemispheric values of hemodynamic parameters in the territory of the diseased artery at follow-up were correlated with the mean blood pressure values at the baseline and follow-up examinations. There was a positive linear relationship between the degree of hemodynamic improvement and systolic blood pressure. Patients with low systolic blood pressure (<130 mmHg) (n = 18) showed hemodynamic deterioration as indicated by significant decreases in cerebral blood flow, cerebral blood flow/cerebral blood volume ratio, and increases in oxygen extraction fraction during follow-up. In contrast, there were no significant changes in patients without low systolic blood pressure. In patients with atherosclerotic internal carotid artery or middle cerebral artery disease and no ischemic episodes of stroke during follow-up, lower systolic blood pressure was associated with lesser hemodynamic improvement.