Effect of Intracranial Stenosis Revascularization on Dynamic and Static Cerebral Autoregulation

Abstract

Introduction—Severe intracranial stenosis might lead to acute cerebral ischemia. It is imperative to better
assess patients who may benefit from immediate reperfusion and blood pressure management to prevent
injury to peri-infarct tissue.
Methods—We assessed cerebral autoregulation using static and dynamic methods in an 81-year-old
woman suffering acute cerebral ischemia from severe intracranial stenosis in the petrous segment of the left
internal carotid artery (LICA).
Results—Static cerebral autoregulation, which is evaluated by magnetic resonance imaging and magnetic
resonance perfusion studies showed a progression of infarcts and a large perfusion–diffusion mismatch in
the entire LICA territory between the second and third days after onset despite maximized medical therapy.
Dynamic methods, including transfer function analysis and mean velocity index, demonstrated an increasingly impaired dynamic cerebral autoregulation (DCA) on the affected side between these days. Revascularization through acute intracranial stenting resulted in improved perfusion in the LICA territory and normalization of both dynamic and static cerebral autoregulation.
Conclusion—Thus, DCA, a noninvasive bedside method, may be useful in helping to identify and select
patients with large-vessel flow-failure syndromes that would benefit from immediate revascularization of
intracranial atherosclerotic disease.