Impaired cerebrovascular reactivity is associated with recurrent stroke in patients with severe intracranial arterial stenosis: A C02 BOLD fMRI study - 27/05/20

Doi : 10.1016/j.neurad.2020.04.005

Jérémie Papassin ^a,^b,^c, Olivier Heck ^d, Eric Condamine ^e, Johan Pietras ^e, Olivier Detante ^a,^c, Alexandre Krainik ^c,^d,^e,⁎
^a Stroke Unit, Grenoble Alps University Hospital, 38043 Grenoble, France
^b Stroke Unit, Metropole Savoie Hospital, 73000 Chambéry, France
^c University Grenoble Alps, Grenoble Institute of Neurosciences, 38042 Grenoble, France
^d Department of Neuroradiology, Grenoble Alps University Hospital, 38043 Grenoble, France
^e Inserm, CNRS, University Grenoble Alps, Grenoble Alps University Hospital, IRMaGe, CS 10217, 38043 Grenoble cedex 9, France

^⁎Corresponding author at: Department of Neuroradiology, Grenoble Alps University Hospital, 38043 Grenoble, France.Department of Neuroradiology, Grenoble Alps University HospitalGrenoble38043France

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Graphical abstract

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Highlights

•	Hypercapnic BOLD fMRI is feasible and safe to assess cerebrovascular reserve in patients referred for a symptomatic severe intracranial arterial stenosis (SIAS).
•	Impaired cerebrovascular reactivity (CVR) is associated with an increased rate of recurrent stroke in SAIS patients.
•	CVR mapping may be useful for selecting high-risk patients for future trials evaluating alternative for SIAS.

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Abstract

Background and Purpose

Severe intracranial atherosclerotic stenosis (SIAS) remains at risk of recurrent ischemic events despite intensive medical management. Exhausted cerebrovascular reserve seems to be associated with higher risk of recurrent stroke.

Materials and Methods

We used whole brain MRI to estimate basal perfusion using dynamic susceptibility contrast and cerebrovascular reactivity (CVR) to hypercapnic challenge (CO2 inhalation) using BOLD contrast, in 20 patients with symptomatic SIAS (>70%) of the middle cerebral artery (MCA) or the distal internal carotid artery. We studied relationships between individual clinical, biological, radiological baseline characteristics, recurrent ischemic events, basal perfusion parameters (mean transit time, delay, time to peak, cerebral blood flow and volume), and CVR measured in MCA territories (CVRMCA), and reported using laterality indices (LI).

Results

Ten patients had an impaired CVR with (|LI| CVRMCA≥0.08). During a mean follow-up of 3.3 years, all recurrent ipsilateral ischemic events occurred within the first year. They were more frequent in impaired CVRMCA group (n=7/10 patients) than in normal CVRMCA group (n=1/10), with different survival curves (log rank, P=0.007).

Conclusion

Impaired CVR is associated with an increased rate of recurrent stroke in patients with symptomatic SIAS. CVR mapping should be used as a well tolerated method to select higher-risk patients in further therapeutic trials such as endovascular procedures.

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Keywords : Stroke, Intracranial arterial stenosis, BOLD fMRI, Hypercapnia, Cerebral vascular reserve, Cerebral vascular reactivity