Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion

Abstract Cerebral perfusion is determined by segmental perfusion pressure for the intracranial compartment (SPP), which is lower than cerebral perfusion pressure (CPP) because of extracranial stenosis. We used the Thevenin model of Starling resistors to represent the intra-extra-cranial compartments...

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Autores principales:	Mindaugas Pranevicius, Henrikas Pranevicius, Osvaldas Pranevicius
Formato:	article
Lenguaje:	EN
Publicado:	Nature Portfolio 2021
Materias:	Medicine R Science Q
Acceso en línea:	https://doaj.org/article/f8919746badc409aa73adf3f6279074b
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spelling	oai:doaj.org-article:f8919746badc409aa73adf3f6279074b2021-12-02T14:37:46ZCerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion10.1038/s41598-021-85931-x2045-2322https://doaj.org/article/f8919746badc409aa73adf3f6279074b2021-04-01T00:00:00Zhttps://doi.org/10.1038/s41598-021-85931-xhttps://doaj.org/toc/2045-2322Abstract Cerebral perfusion is determined by segmental perfusion pressure for the intracranial compartment (SPP), which is lower than cerebral perfusion pressure (CPP) because of extracranial stenosis. We used the Thevenin model of Starling resistors to represent the intra-extra-cranial compartments, with outflow pressures ICP and Pe, to express SPP = Pd–ICP = FFR*CPP–Ge(1 − FFR)(ICP–Pe). Here Pd is intracranial inflow pressure in the circle of Willis, ICP—intracranial pressure; FFR = Pd/Pa is fractional flow reserve (Pd scaled to the systemic pressure Pa), Ge—relative extracranial conductance. The second term (cerebral venous steal) decreases SPP when FFR < 1 and ICP > Pe. We verified the SPP equation in a bench of fluid flow through the collapsible tubes. We estimated Pd, measuring pressure in the intra-extracranial collateral (supraorbital artery) in a volunteer. To manipulate extracranial outflow pressure Pe, we inflated the infraorbital cuff, which led to the Pd increase and directional Doppler flow signal reversal in the supraorbital artery. SPP equation accounts for the hemodynamic effect of inflow stenosis and intra-extracranial flow diversion, and is a more precise perfusion pressure target than CPP for the intracranial compartment. Manipulation of intra-extracranial pressure gradient ICP–Pe can augment intracranial inflow pressure (Pd) and reverse intra-extracranial steal.Mindaugas PraneviciusHenrikas PraneviciusOsvaldas PraneviciusNature PortfolioarticleMedicineRScienceQENScientific Reports, Vol 11, Iss 1, Pp 1-10 (2021)
institution	DOAJ
collection	DOAJ
language	EN
topic	Medicine R Science Q
spellingShingle	Medicine R Science Q Mindaugas Pranevicius Henrikas Pranevicius Osvaldas Pranevicius Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion
description	Abstract Cerebral perfusion is determined by segmental perfusion pressure for the intracranial compartment (SPP), which is lower than cerebral perfusion pressure (CPP) because of extracranial stenosis. We used the Thevenin model of Starling resistors to represent the intra-extra-cranial compartments, with outflow pressures ICP and Pe, to express SPP = Pd–ICP = FFR*CPP–Ge(1 − FFR)(ICP–Pe). Here Pd is intracranial inflow pressure in the circle of Willis, ICP—intracranial pressure; FFR = Pd/Pa is fractional flow reserve (Pd scaled to the systemic pressure Pa), Ge—relative extracranial conductance. The second term (cerebral venous steal) decreases SPP when FFR < 1 and ICP > Pe. We verified the SPP equation in a bench of fluid flow through the collapsible tubes. We estimated Pd, measuring pressure in the intra-extracranial collateral (supraorbital artery) in a volunteer. To manipulate extracranial outflow pressure Pe, we inflated the infraorbital cuff, which led to the Pd increase and directional Doppler flow signal reversal in the supraorbital artery. SPP equation accounts for the hemodynamic effect of inflow stenosis and intra-extracranial flow diversion, and is a more precise perfusion pressure target than CPP for the intracranial compartment. Manipulation of intra-extracranial pressure gradient ICP–Pe can augment intracranial inflow pressure (Pd) and reverse intra-extracranial steal.
format	article
author	Mindaugas Pranevicius Henrikas Pranevicius Osvaldas Pranevicius
author_facet	Mindaugas Pranevicius Henrikas Pranevicius Osvaldas Pranevicius
author_sort	Mindaugas Pranevicius
title	Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion
title_short	Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion
title_full	Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion
title_fullStr	Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion
title_full_unstemmed	Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion
title_sort	cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion
publisher	Nature Portfolio
publishDate	2021
url	https://doaj.org/article/f8919746badc409aa73adf3f6279074b
work_keys_str_mv	AT mindaugaspranevicius cerebralvenousstealequationforintracranialsegmentalperfusionpressurepredictsandquantifiesreversibleintracranialtoextracranialflowdiversion AT henrikaspranevicius cerebralvenousstealequationforintracranialsegmentalperfusionpressurepredictsandquantifiesreversibleintracranialtoextracranialflowdiversion AT osvaldaspranevicius cerebralvenousstealequationforintracranialsegmentalperfusionpressurepredictsandquantifiesreversibleintracranialtoextracranialflowdiversion
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Cerebral venous steal equation for intracranial segmental perfusion pressure predicts and quantifies reversible intracranial to extracranial flow diversion

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