Integrative cerebral blood flow regulation in ischemic stroke

J Cereb Blood Flow Metab. 2022 Mar;42(3):387-403. doi: 10.1177/0271678X211032029. Epub 2021 Jul 14.

Abstract

Optimizing cerebral perfusion is key to rescuing salvageable ischemic brain tissue. Despite being an important determinant of cerebral perfusion, there are no effective guidelines for blood pressure (BP) management in acute stroke. The control of cerebral blood flow (CBF) involves a myriad of complex pathways which are largely unaccounted for in stroke management. Due to its unique anatomy and physiology, the cerebrovascular circulation is often treated as a stand-alone system rather than an integral component of the cardiovascular system. In order to optimize the strategies for BP management in acute ischemic stroke, a critical reappraisal of the mechanisms involved in CBF control is needed. In this review, we highlight the important role of collateral circulation and re-examine the pathophysiology of CBF control, namely the determinants of cerebral perfusion pressure gradient and resistance, in the context of stroke. Finally, we summarize the state of our knowledge regarding cardiovascular and cerebrovascular interaction and explore some potential avenues for future research in ischemic stroke.

Keywords: Ischemic stroke; cerebral blood flow; neurovascular physiology.

Publication types

  • Review

MeSH terms

  • Animals
  • Brain / blood supply*
  • Brain / physiopathology*
  • Cerebrovascular Circulation / physiology*
  • Collateral Circulation / physiology
  • Humans
  • Ischemic Stroke / physiopathology*