Linearity and Non-linearity of Cerebral Autoregulation

NCT ID: NCT04611672

Last Updated: 2022-08-26

Basic Information

• Recruitment Status: RECRUITING
• Total Enrollment: 580 participants
• Study Classification: OBSERVATIONAL
• Study Start Date: 2020-10-11
• Study Completion Date: 2025-12-31

Brief Summary

Injured brain tissue supplied by a disturbed state of cerebral autoregulation (CA) is at risk of secondary ischemia, e.g. in patients with stroke, subarachnoid hemorrhage, intracerebral hemorrhage or bacterial Meningitis. Up to now, there is lack of a simple and easy to perform bed side test that would allow for to intervene when CA failure is indicated. For this purpose, we explore the dynamics of the interplay between blood pressure and cerebral blood flow velocity using transcranial Doppler ultrasound (or near infrared spectroscopy derived haemoglobin concentration changes) as a measure of CA. To describe these dynamics different mathematical models are used, but they all still need validation and proof of concept because these dynamics are poorly understood with respect to the factors which influence the composition of the mathematical models.

Objectives: To what amount is CA disturbed in the different stroke subgroups ? Is a disturbed CA a risk factor of poorer outcome ?

Detailed Description

We investigate which factors determine the dynamics of CA under the assumption that disturbed dynamics of the relation blood pressure (BP) - cerebral blood flow velocity CBFv) indicate a disturbed CA. Factors to be considered relevant are BP, blood carbon dioxide (CO2) concentration (measured as endtidal CO2 concentration), autonomic nervous system function such as heart rate, pulse pressure amplitude and baroreflex sensitivity, movement or psychological tasks, and in the patients the kind and the severity of the underlying disease. Via different mathematical models the effects of these variables on CBFv as the Output function is evaluated. The most frequently used approach is the use of Transfer functions.

In the registry will include the patients with acute strokes hospitalized at our stroke center. We will include every stroke patient with any Kind and severity of stroke syndromes who gives informed consent and who has a so called temporal ultrasound window to insonate the middle cerebral artery. BP will be measure noninvasively by a Finapres device. Items registered are Age, gender, cerebrovascular risk factors, temperature, mean BP and ist variability on days 1-3, stroke classification using TOAST, Perfusion Computed Tomography and MRI, and at the time of the simultaneous recordings of CBFv and BP the endtidal CO2, mean BP, mean pulsatility index, and after Transfer function analysis coherence, gain and Phase in different frequency ranges

Conditions

Stroke, Acute

Study Design

• Observational Model Type: COHORT
• Study Time Perspective: PROSPECTIVE

Study Groups

Patients with stroke

Patients with stroke of all subtypes, with and without different Kind of Lysis therapy

Assessment of CA

Intervention Type: DIAGNOSTIC_TEST

As part of our routine stroke work up, each patient receives an initial CT scan with CT perfusion to indicate thrombolysis therapy (intravenous, mechanical, or both, depending on the time since first stroke symptoms and perfusion-mismatch), an MRI within 2 days, extracranial and transcranial Duplex ultrasound, echocardiography, continuous Monitoring of BP, O2, body temperature, NIHSS and Glagow Coma Scale (GCS) every 6 hours. Assessing CA by continuous recording of blood pressure, cerebral blood flow velocity, end-tidal CO2. Analysis via Transfer function estimates

Controls

Healthy controls of all Ages above 18 years

Assesment of CA only

Intervention Type: DIAGNOSTIC_TEST

Assessing CA by continuous recording of blood pressure, cerebral blood flow velocity, end-tidal CO2. Analysis via Transfer function estimates

Interventions

Assessment of CA

As part of our routine stroke work up, each patient receives an initial CT scan with CT perfusion to indicate thrombolysis therapy (intravenous, mechanical, or both, depending on the time since first stroke symptoms and perfusion-mismatch), an MRI within 2 days, extracranial and transcranial Duplex ultrasound, echocardiography, continuous Monitoring of BP, O2, body temperature, NIHSS and Glagow Coma Scale (GCS) every 6 hours. Assessing CA by continuous recording of blood pressure, cerebral blood flow velocity, end-tidal CO2. Analysis via Transfer function estimates

Intervention Type: DIAGNOSTIC_TEST

Assesment of CA only

Assessing CA by continuous recording of blood pressure, cerebral blood flow velocity, end-tidal CO2. Analysis via Transfer function estimates

Intervention Type: DIAGNOSTIC_TEST

Eligibility Criteria

Inclusion Criteria

• every typ of ischemic stroke of any severity
• presence of a "temporal bone window"

Exclusion Criteria

• Age < 18 years,
• pregnancy
• no informed consent.
• absence of a "temporal bone window"

• Minimum Eligible Age: 18 Years
• Maximum Eligible Age: 110 Years
• Eligible Sex: ALL
• Accepts Healthy Volunteers: No

Sponsors

Luzerner Kantonsspital

OTHER

Sponsor Role: lead

Responsible Party

Martin Müller

Prof Dr med

Responsibility Role: PRINCIPAL_INVESTIGATOR

Principal Investigators

Martin Müller, MD

Role: PRINCIPAL_INVESTIGATOR

Luzerner Kantonsspital

Locations

Kantonsspital Luzern

Lucerne, , Switzerland

Site Status: RECRUITING

Countries

Switzerland

Central Contacts

Martin Müller, MD

Role: CONTACT

martin.mueller@luks.ch

+41 41 205 ext. 5113

Lehel Lakatos, MD

Role: CONTACT

Lehel-Barna.Lakatos@luks.ch

+41 41 205 ext. 6266

Facility Contacts

Martin Müller, MD

Role: primary

martin.mueller@luks.ch

+41 41 205 ext. 5133

Lehel Lakatos, MD

Role: backup

Lehel-Barna.Lakatos@luks.ch

+41 41 205 ext. 6266

References

Beishon L, Minhas JS, Nogueira R, Castro P, Budgeon C, Aries M, Payne S, Robinson TG, Panerai RB. INFOMATAS multi-center systematic review and meta-analysis individual patient data of dynamic cerebral autoregulation in ischemic stroke. Int J Stroke. 2020 Oct;15(7):807-812. doi: 10.1177/1747493020907003. Epub 2020 Feb 24.

Reference Type: BACKGROUND

PMID: 32090712 (View on PubMed)

Meel-van den Abeelen AS, Simpson DM, Wang LJ, Slump CH, Zhang R, Tarumi T, Rickards CA, Payne S, Mitsis GD, Kostoglou K, Marmarelis V, Shin D, Tzeng YC, Ainslie PN, Gommer E, Muller M, Dorado AC, Smielewski P, Yelicich B, Puppo C, Liu X, Czosnyka M, Wang CY, Novak V, Panerai RB, Claassen JA. Between-centre variability in transfer function analysis, a widely used method for linear quantification of the dynamic pressure-flow relation: the CARNet study. Med Eng Phys. 2014 May;36(5):620-7. doi: 10.1016/j.medengphy.2014.02.002. Epub 2014 Apr 13.

Reference Type: BACKGROUND

PMID: 24725709 (View on PubMed)

Claassen JA, Meel-van den Abeelen AS, Simpson DM, Panerai RB; international Cerebral Autoregulation Research Network (CARNet). Transfer function analysis of dynamic cerebral autoregulation: A white paper from the International Cerebral Autoregulation Research Network. J Cereb Blood Flow Metab. 2016 Apr;36(4):665-80. doi: 10.1177/0271678X15626425. Epub 2016 Jan 18.

Reference Type: BACKGROUND

PMID: 26782760 (View on PubMed)

Muller M, Osterreich M, Lakatos L, Hessling AV. Cerebral macro- and microcirculatory blood flow dynamics in successfully treated chronic hypertensive patients with and without white mater lesions. Sci Rep. 2020 Jun 8;10(1):9213. doi: 10.1038/s41598-020-66317-x.

Reference Type: RESULT

PMID: 32514031 (View on PubMed)

Muller M, Osterreich M, von Hessling A, Smith RS. Incomplete recovery of cerebral blood flow dynamics in sufficiently treated high blood pressure. J Hypertens. 2019 Feb;37(2):372-379. doi: 10.1097/HJH.0000000000001854.

Reference Type: RESULT

PMID: 29995701 (View on PubMed)

Lakatos LB, Bolognese M, Oesterreich M, Muller M, Karwacki GM. Cerebrovascular regulation in patients with active tumors and an acute ischemic stroke: a retrospective analysis. Front Physiol. 2024 Dec 19;15:1423195. doi: 10.3389/fphys.2024.1423195. eCollection 2024.

Reference Type: DERIVED

PMID: 39749040 (View on PubMed)

Bolognese M, Weichsel L, Osterreich M, Muller M, Karwacki GM, Lakatos LB. Association of high-sensitivity cardiac troponin T with territorial middle cerebral artery brain infarctions and dynamic cerebral autoregulation. J Cent Nerv Syst Dis. 2024 Nov 25;16:11795735241302725. doi: 10.1177/11795735241302725. eCollection 2024.

Reference Type: DERIVED

PMID: 39600968 (View on PubMed)

Lakatos LB, Shin DC, Muller M, Osterreich M, Marmarelis V, Bolognese M. Impaired dynamic cerebral autoregulation measured in the middle cerebral artery in patients with vertebrobasilar ischemia is associated with autonomic failure. J Stroke Cerebrovasc Dis. 2024 Jan;33(1):107454. doi: 10.1016/j.jstrokecerebrovasdis.2023.107454. Epub 2023 Nov 4.

Reference Type: DERIVED

PMID: 37931481 (View on PubMed)

Other Identifiers

PB_2016-01719

Identifier Type: -

Identifier Source: org_study_id