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Relationship of Vascular Wall Tension and Autoregulation Following Traumatic Brain Injury

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Abstract

Background

The vascular wall tension (WT) of small cerebral vessels can be quantitatively estimated through the concept of critical closing pressure (CrCP), which denotes the lower limit of arterial blood pressure (ABP), below which small cerebral arterial vessels collapse and blood flow ceases. WT can be expressed as the difference between CrCP and intracranial pressure (ICP) and represent active vasomotor tone. In this study, we investigated the association of WT and CrCP with autoregulation and outcome of a large group of patients after traumatic brain injury (TBI).

Methods

We retrospectively analysed recordings of ABP, ICP and transcranial Doppler (TCD) blood flow velocity from 280 TBI patients (median age: 29 years; interquartile range: 20–43). CrCP and WT were calculated using the cerebrovascular impedance methodology. Autoregulation was assessed based on TCD-based indices, Mx and ARI.

Results

Low values of WT were found to be associated with an impaired autoregulatory capacity, signified by its correlation to FV-based indices Mx (R = −0.138; p = 0.021) and ARI (R = 0.118; p = 0.048). No relationship could be established between CrCP and any of the autoregulatory indices. Neither CrCP nor WT was found to correlate with outcome.

Conclusions

Impaired autoregulation was found to be associated with a lower WT supporting the role of vasoparalysis in the loss of autoregulatory capacity. In contrast, no links between CrCP and autoregulation could be identified.

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Acknowledgments

We would like to thank Gordon Stevenson, PhD, from Evelyn Perinatal Imaging Center, Rosie Hospital, Cambridge, for proof reading of this article. GVV is supported by an A. G. Leventis Foundation Scholarship, and a Charter Studentship from St Edmund’s College, Cambridge. AGK is supported by a Royal College of Surgeons of England Research Fellowship, a National Institute for Health Research (NIHR) Academic Clinical Fellowship, and a Raymond and Beverly Sackler Studentship. PJH is supported by an NIHR Research Professorship, the NIHR Cambridge Biomedical Research Centre and has been appointed as the Surgical Specialty Lead for Neurosurgery, Royal College of Surgeons of England Clinical Research Initiative. JDP is supported by the NIHR Cambridge Biomedical Research Centre and an NIHR Senior Investigator Award. MC is NIHR Cambridge Biomedical Research Centre principal investigator on cerebrospinal dynamics.

Conflict of interest

ICM+ Software is licensed by Cambridge Enterprise, Cambridge, UK, http://www.neurosurg.cam.ac.uk/icmplus/. MC and PS have a financial interest in a fraction of the licensing fee. The corresponding author and the rest of the co-authors do not have any conflict of interest.

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Authors and Affiliations

  1. Division of Neurosurgery, Department of Clinical Neurosciences, Addenbrooke’s Hospital, University of Cambridge, Hills Road, Cambridge, CB2 0QQ, UK

    Georgios V. Varsos, Karol P. Budohoski, Angelos G. Kolias, Xiuyun Liu, Peter Smielewski, Peter J. Hutchinson, John D. Pickard & Marek Czosnyka

  2. Department of Neurosurgery, Red Cross Hospital, Athens, Greece

    Vassilis G. Varsos

  3. Institute of Electronic Systems, Warsaw University of Technology, Warsaw, Poland

    Marek Czosnyka

Authors
  1. Georgios V. Varsos
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  2. Karol P. Budohoski
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  9. Marek Czosnyka
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Correspondence to Georgios V. Varsos.

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Varsos, G.V., Budohoski, K.P., Kolias, A.G. et al. Relationship of Vascular Wall Tension and Autoregulation Following Traumatic Brain Injury. Neurocrit Care 21, 266–274 (2014). https://doi.org/10.1007/s12028-014-9971-1

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