Characteristics of dynamic cerebral autoregulation in cerebral small vessel disease: Diffuse and sustained

TL;DR

This study shows that cerebral autoregulation is globally and persistently impaired in patients with lacunar infarction, a type of small vessel disease.

Contribution

The study reveals that autoregulation impairments are diffuse and sustained, not limited to the stroke-affected region.

Findings

Impairments in dynamic cerebral autoregulation were observed in both MCAs and PCAs in MCA territory stroke patients.

Similar impairments were found in PCA territory stroke patients, affecting both MCAs and PCAs.

The autoregulation impairments remained unchanged over a 6-month follow-up period.

Abstract

Cerebral small vessel disease is a major cause of stroke and vascular dementia; however, the pathogenesis is largely unclear. In this study, we investigated the characteristics of the impairment of dynamic cerebral autoregulation (dCA) in lacunar infarction patients. Seventy-one lacunar infarction patients were enrolled in the study, including 46 unilateral middle cerebral artery (MCA) territory stroke patients and 25 unilateral posterior cerebral artery (PCA) territory stroke patients. Each group of patients was randomly divided into two subgroups. Group 1 underwent dCA assessments in the bilateral MCAs, and Group 2 underwent dCA assessments in the bilateral PCAs. All patients were followed up for 6 months. Transfer function analysis was applied to derive the autoregulatory parameters of gain and phase difference. In the unilateral MCA territory stroke patients, impairments of dCA were observed in both the MCAs and PCAs, and the same results were observed in the unilateral PCA territory stroke patients. These impairments remained unchanged during the 6-month follow-up. In lacunar infarction, which is most prevalent type of cerebral small vessel disease, though patients with unilateral MCA territory/PCA territory stroke, the impairments of dCA were global and sustained. This finding suggests that the physiological changes associated with lacunar infarction were diffuse.

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