Review of studies on dynamic cerebral autoregulation in the acute phase of stroke and the relationship with clinical outcome.
Ricardo de Carvalho NogueiraMarcel AriesJatinder S MinhasNils H PetersenLi XiongJana M KainerstorferPedro CastroPublished in: Journal of cerebral blood flow and metabolism : official journal of the International Society of Cerebral Blood Flow and Metabolism (2021)
Acute stroke is associated with high morbidity and mortality. In the last decades, new therapies have been investigated with the aim of improving clinical outcomes in the acute phase post stroke onset. However, despite such advances, a large number of patients do not demonstrate improvement, furthermore, some unfortunately deteriorate. Thus, there is a need for additional treatments targeted to the individual patient. A potential therapeutic target is interventions to optimize cerebral perfusion guided by cerebral hemodynamic parameters such as dynamic cerebral autoregulation (dCA). This narrative led to the development of the INFOMATAS (Identifying New targets FOr Management And Therapy in Acute Stroke) project, designed to foster interventions directed towards understanding and improving hemodynamic aspects of the cerebral circulation in acute cerebrovascular disease states. This comprehensive review aims to summarize relevant studies on assessing dCA in patients suffering acute ischemic stroke, intracerebral haemorrhage, and subarachnoid haemorrhage. The review will provide to the reader the most consistent findings, the inconsistent findings which still need to be explored further and discuss the main limitations of these studies. This will allow for the creation of a research agenda for the use of bedside dCA information for prognostication and targeted perfusion interventions.
Keyphrases
- subarachnoid hemorrhage
- end stage renal disease
- acute ischemic stroke
- ejection fraction
- chronic kidney disease
- newly diagnosed
- physical activity
- cerebral ischemia
- prognostic factors
- healthcare
- cerebral blood flow
- liver failure
- risk assessment
- magnetic resonance imaging
- intensive care unit
- high resolution
- drug delivery
- atrial fibrillation
- public health
- case control
- case report
- cancer therapy
- bone marrow
- respiratory failure
- patient reported outcomes
- mass spectrometry
- quality improvement
- mesenchymal stem cells
- global health
- health information