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Cerebral arterial pulsatility is associated with features of small vessel disease in patients with acute stroke and TIA: a 4D flow MRI study
Umeå University, Faculty of Medicine, Department of Clinical Sciences, Neurosciences. Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.ORCID iD: 0000-0001-6331-4283
Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Medicine, Umeå Centre for Functional Brain Imaging (UFBI).ORCID iD: 0000-0001-6784-1945
Umeå University, Faculty of Medicine, Department of Radiation Sciences. Umeå University, Faculty of Science and Technology, Centre for Biomedical Engineering and Physics (CMTF).
Umeå University, Faculty of Medicine, Department of Pharmacology and Clinical Neuroscience.ORCID iD: 0000-0001-6451-1940
2020 (English)In: Journal of Neurology, ISSN 0340-5354, E-ISSN 1432-1459, Vol. 267, no 3, p. 721-730Article in journal (Refereed) Published
Abstract [en]

Cerebral small vessel disease (SVD) is a major cause of stroke and cognitive impairment. However, the underlying mechanisms behind SVD are still poorly understood. High cerebral arterial pulsatility has been suggested as a possible cause of SVD. In population studies, arterial pulsatility has been linked to white matter hyperintensities (WMH), cerebral atrophy, and cognitive impairment, all features of SVD. In stroke, pulsatility data are scarce and contradictory. The aim of this study was to investigate the relationship between arterial pulsatility and SVD in stroke patients. With a cross-sectional design, 89 patients with acute ischemic stroke or TIA were examined with MRI. A neuropsychological assessment was performed 1 year later. Using 4D flow MRI, pulsatile indices (PI) were calculated for the internal carotid artery (ICA) and middle cerebral artery (M1, M3). Flow volume pulsatility (FVP), a measure corresponding to the cyclic expansion of the arterial tree, was calculated for the same locations. These parameters were assessed for associations with WMH volume, brain volume and cognitive function. ICA-FVP was associated with WMH volume (β = 1.67, 95% CI: [0.1, 3.24], p = 0.037). M1-PI and M1-FVP were associated with decreasing cognitive function (β = - 4.4, 95% CI: [- 7.7, - 1.1], p = 0.009 and β = - 13.15, 95% CI: [- 24.26, - 2.04], p = 0.02 respectively). In summary, this supports an association between arterial pulsatility and SVD in stroke patients, and provides a potential target for further research and preventative treatment. FVP may become a useful biomarker for assessing pulsatile stress with PCMRI and 4D flow MRI.

Place, publisher, year, edition, pages
Springer, 2020. Vol. 267, no 3, p. 721-730
Keywords [en]
4D flow MRI, Pulsatile index, Pulsatility, Small vessel disease, White matter hyperintensities
National Category
Neurology
Research subject
Neurology
Identifiers
URN: urn:nbn:se:umu:diva-167287DOI: 10.1007/s00415-019-09620-6ISI: 000515353700019PubMedID: 31728712OAI: oai:DiVA.org:umu-167287DiVA, id: diva2:1385691
Funder
Swedish Research Council, 2015-05616Swedish Research Council, 2017-04949Swedish Heart Lung Foundation, 20110383Swedish Heart Lung Foundation, 20140592The Swedish Brain FoundationAvailable from: 2020-01-15 Created: 2020-01-15 Last updated: 2020-03-19Bibliographically approved

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Birnefeld, JohanWåhlin, AndersEklund, AndersMalm, Jan
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NeurosciencesDepartment of Pharmacology and Clinical NeuroscienceDepartment of Radiation SciencesUmeå Centre for Functional Brain Imaging (UFBI)Centre for Biomedical Engineering and Physics (CMTF)
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