http://online.liebertpub.com/doi/abs/10.1089/ars.2013.5669
Dr. Katherine Jackman
Weill Cornell Medical College, Brain and Mind Research Institute, 407 East 61st St, New York, New York, United States, 10065; kaj2009@med.cornell.edu
Dr. Costantino Iadecola
Weill Cornell Medical College, Brain and Mind Research Institute, New York, New York, United States; coi2001@med.cornell.edu
Accepted: November 19 2013
Received: November 19 2013
Received: November 19 2013
ABSTRACT
Significance:
The brain has high energetic requirements and is therefore highly
dependent on adequate cerebral blood supply. In order to compensate for
dangerous fluctuations in cerebral perfusion, the circulation of the
brain has evolved intrinsic safeguarding measures. Recent advances
& critical issues: The vascular network of the brain incorporates a
high degree of redundancy, allowing the redirection and redistribution
of blood flow in the event of vascular occlusion. Furthermore, active
responses such as cerebral autoregulation, which acts to maintain
constant cerebral blood flow in response to changing blood pressure, and
functional hyperemia, which couples blood supply with synaptic
activity, allows the brain to maintain adequate cerebral perfusion in
the face of varying supply or demand. In the presence of stroke risk
factors, such as hypertension and diabetes, these protective processes
are impaired and the susceptibility of the brain to ischemic injury is
increased. One potential mechanism for the increased injury is that
collateral flow arising from the normally perfused brain and supplying
blood flow to the ischemic region is suppressed, resulting in more
severe ischemia. Future directions: Approaches to support collateral
flow may ameliorate the outcome of focal cerebral ischemia by rescuing
cerebral perfusion in potentially viable regions of the ischemic
territory.
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