Regional dynamic cerebral autoregulation across anterior and posterior circulatory territories:A detailed exploration and its clinical implications
作者机构：Department of NeurologyUniversity of Massachusetts Chan Medical SchoolWorcesterMA 01655United States Department of NeurologyUniversity of MassachusettsWorcesterMA 01655United States
出 版 物：《World Journal of Critical Care Medicine》 (世界重症医学杂志（英文）)
年 卷 期：2024年第13卷第4期
页 面：25-34页
主 题：Cerebral autoregulation Anterior circulation Posterior circulation Posterior cerebral artery Regional cerebral autoregulation Transcranial doppler Near-infrared spectroscopy Transfer function analysis Cerebral energetics
摘 要：Cerebral autoregulation(CA)is the mechanism that maintains stable cerebral blood flow(CBF)despite fluctuations in systemic blood pressure,crucial for brain *** evidence highlights distinct regional variations in CA between the anterior(carotid)and posterior(vertebrobasilar)*** neuromonitoring techniques,such as transcranial Doppler,transfer function analysis,and near-infrared spectroscopy,facilitate the dynamic assessment of CBF and *** indicate a robust autoregulatory capacity in the anterior circulation,characterized by rapid adjustments in vascular *** the contrary,the posterior circulation,mainly supplied by the vertebral arteries,may have a lower autoregulatory *** acute brain injuries such as intracerebral and subarachnoid hemorrhage,and traumatic brain injuries,dynamic CA can be significantly altered in the posterior *** physiological mechanisms of impaired CA in the posterior circulation include:(1)Decreased sympathetic innervation of the vasculature impairing compensatory vasoreactivity;(2)Endothelial dysfunction;(3)Increased cerebral metabolic rate of oxygen consumption within the visual cortex causing CBFmetabolism(i.e.,neurovascular)uncoupling;and(4)Impaired blood-brain barrier integrity leading to impaired astrocytic mediated release of vasoactive substances(*** oxide,potassium,and calcium ions).Furthermore,more research is needed on the effects of collateral circulation,as well as the circle of Willis variants,such as the fetal-type posterior cerebral artery,on dynamic *** our understanding of these mechanisms is crucial to improving the diagnosis,prognosis,and management of various cerebrovascular disorders.
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