The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model.
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The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model. / Østergaard, Leif; Jespersen, Sune Nørhøj; Mouridsen, Kim; Mikkelsen, Irene Klærke; Jonsdottír, Kristjana Ýr; Tietze, Anna; Blicher, Jakob Udby; Aamand, Rasmus; Hjort, Niels; Iversen, Nina Kerting; Cai, Changsi; Hougaard, Kristina Dupont; Simonsen, Claus Z; Paul, Von Weitzel-Mudersbach; Modrau, Boris; Nagenthiraja, Kartheeban; Lars, Riisgaard Ribe; Hansen, Mikkel Bo; Bekke, Susanne Lise; Dahlman, Martin Gervais; Puig, Josep; Pedraza, Salvador; Serena, Joaquín; Cho, Tae-Hee; Siemonsen, Susanne; Thomalla, Götz; Fiehler, Jens; Nighoghossian, Norbert; Andersen, Grethe.
in: J CEREBR BLOOD F MET, Jahrgang 33, Nr. 5, 5, 2013, S. 635-648.Publikationen: SCORING: Beitrag in Fachzeitschrift/Zeitung › SCORING: Zeitschriftenaufsatz › Forschung › Begutachtung
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TY - JOUR
T1 - The role of the cerebral capillaries in acute ischemic stroke: the extended penumbra model.
AU - Østergaard, Leif
AU - Jespersen, Sune Nørhøj
AU - Mouridsen, Kim
AU - Mikkelsen, Irene Klærke
AU - Jonsdottír, Kristjana Ýr
AU - Tietze, Anna
AU - Blicher, Jakob Udby
AU - Aamand, Rasmus
AU - Hjort, Niels
AU - Iversen, Nina Kerting
AU - Cai, Changsi
AU - Hougaard, Kristina Dupont
AU - Simonsen, Claus Z
AU - Paul, Von Weitzel-Mudersbach
AU - Modrau, Boris
AU - Nagenthiraja, Kartheeban
AU - Lars, Riisgaard Ribe
AU - Hansen, Mikkel Bo
AU - Bekke, Susanne Lise
AU - Dahlman, Martin Gervais
AU - Puig, Josep
AU - Pedraza, Salvador
AU - Serena, Joaquín
AU - Cho, Tae-Hee
AU - Siemonsen, Susanne
AU - Thomalla, Götz
AU - Fiehler, Jens
AU - Nighoghossian, Norbert
AU - Andersen, Grethe
PY - 2013
Y1 - 2013
N2 - The pathophysiology of cerebral ischemia is traditionally understood in relation to reductions in cerebral blood flow (CBF). However, a recent reanalysis of the flow-diffusion equation shows that increased capillary transit time heterogeneity (CTTH) can reduce the oxygen extraction efficacy in brain tissue for a given CBF. Changes in capillary morphology are typical of conditions predisposing to stroke and of experimental ischemia. Changes in capillary flow patterns have been observed by direct microscopy in animal models of ischemia and by indirect methods in humans stroke, but their metabolic significance remain unclear. We modeled the effects of progressive increases in CTTH on the way in which brain tissue can secure sufficient oxygen to meet its metabolic needs. Our analysis predicts that as CTTH increases, CBF responses to functional activation and to vasodilators must be suppressed to maintain sufficient tissue oxygenation. Reductions in CBF, increases in CTTH, and combinations thereof can seemingly trigger a critical lack of oxygen in brain tissue, and the restoration of capillary perfusion patterns therefore appears to be crucial for the restoration of the tissue oxygenation after ischemic episodes. In this review, we discuss the possible implications of these findings for the prevention, diagnosis, and treatment of acute stroke.
AB - The pathophysiology of cerebral ischemia is traditionally understood in relation to reductions in cerebral blood flow (CBF). However, a recent reanalysis of the flow-diffusion equation shows that increased capillary transit time heterogeneity (CTTH) can reduce the oxygen extraction efficacy in brain tissue for a given CBF. Changes in capillary morphology are typical of conditions predisposing to stroke and of experimental ischemia. Changes in capillary flow patterns have been observed by direct microscopy in animal models of ischemia and by indirect methods in humans stroke, but their metabolic significance remain unclear. We modeled the effects of progressive increases in CTTH on the way in which brain tissue can secure sufficient oxygen to meet its metabolic needs. Our analysis predicts that as CTTH increases, CBF responses to functional activation and to vasodilators must be suppressed to maintain sufficient tissue oxygenation. Reductions in CBF, increases in CTTH, and combinations thereof can seemingly trigger a critical lack of oxygen in brain tissue, and the restoration of capillary perfusion patterns therefore appears to be crucial for the restoration of the tissue oxygenation after ischemic episodes. In this review, we discuss the possible implications of these findings for the prevention, diagnosis, and treatment of acute stroke.
KW - Animals
KW - Humans
KW - Models, Biological
KW - Oxygen/metabolism
KW - Brain/blood supply/metabolism/physiopathology
KW - Brain Ischemia/diagnosis/metabolism/physiopathology/prevention & control
KW - Capillaries/metabolism/physiopathology
KW - Cerebrovascular Circulation
KW - Stroke/diagnosis/metabolism/physiopathology/prevention & control
KW - Animals
KW - Humans
KW - Models, Biological
KW - Oxygen/metabolism
KW - Brain/blood supply/metabolism/physiopathology
KW - Brain Ischemia/diagnosis/metabolism/physiopathology/prevention & control
KW - Capillaries/metabolism/physiopathology
KW - Cerebrovascular Circulation
KW - Stroke/diagnosis/metabolism/physiopathology/prevention & control
M3 - SCORING: Journal article
VL - 33
SP - 635
EP - 648
JO - J CEREBR BLOOD F MET
JF - J CEREBR BLOOD F MET
SN - 0271-678X
IS - 5
M1 - 5
ER -
