Neurovascular Regulation in the Ischemic Brain

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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

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.