WSC 2025 | Understanding and assessing hemodynamic aspects of ICAD
Joanna Schaafsma, MD, PhD, University of Toronto, Toronto, Canada, discusses the hemodynamic mechanisms contributing to stroke risk in intracranial atherosclerotic disease (ICAD) and how novel imaging techniques can help assess cerebral vascular reserve. Prof. Schaafsma highlights that these techniques can mimic daily activities while a patient is in a scanner, allowing for the identification of patients with hemodynamic impairment who are at the highest risk for stroke. This interview took place at the 17th World Stroke Congress (WSC) in Barcelona, Spain.
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Transcript
It’s a good question because hemodynamic aspects of stroke due to ICAD are complex because of a very large individual variation. Luckily, due to technological developments and progress, we now have imaging techniques that do not only measure flow but also cerebral vascular reserve because if patients lie in a scanner it’s a baseline situation where people don’t do their daily activities so flow can be reduced but we don’t know how far it gets further reduced when they do certain activities, which you can mimic with novel imaging techniques such as BOLD MRI using a vasodilator stimulus as CO2 through a mask...
It’s a good question because hemodynamic aspects of stroke due to ICAD are complex because of a very large individual variation. Luckily, due to technological developments and progress, we now have imaging techniques that do not only measure flow but also cerebral vascular reserve because if patients lie in a scanner it’s a baseline situation where people don’t do their daily activities so flow can be reduced but we don’t know how far it gets further reduced when they do certain activities, which you can mimic with novel imaging techniques such as BOLD MRI using a vasodilator stimulus as CO2 through a mask. And that’s how you mimic an activity while a patient is lying in a scanner. It should increase the cerebral blood flow, but in those patients who already maximized compensatory mechanisms for decreased cerebral blood flow may fail on such a stimulus. And that’s what we call hemodynamic impairment. These patients are at the highest risk for stroke. So we want to know details about their hemodynamic status that way and that’s one method and there are numerous other methods to get an assessment of flow and a cerebrovascular reserve to help select the highest risk patients who have intracranial atherosclerotic disease.
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