Arteriovenous cerebral blood flow correlation in moderate-to-severe traumatic brain injury: CT perfusion study

Alex O Trofimov; Darya I Agarkova; Kseniia A Trofimova; Edwin M Nemoto; Olga A Bragina; Denis E Bragin

doi:10.1016/j.bas.2023.102675

Arteriovenous cerebral blood flow correlation in moderate-to-severe traumatic brain injury: CT perfusion study

Brain Spine. 2023 Sep 21:3:102675. doi: 10.1016/j.bas.2023.102675. eCollection 2023.

Authors

Alex O Trofimov^{1

2}, Darya I Agarkova¹, Kseniia A Trofimova¹, Edwin M Nemoto³, Olga A Bragina³, Denis E Bragin^{3

2}

Affiliations

¹ Department of Neurological Diseases, Privolzhsky Research Medical University, Nizhny Novgorod, Russia.
² Lovelace Biomedical Research Institute, Albuquerque, NM, USA.
³ Department of Neurology, University of New Mexico School of Medicine, Albuquerque, USA.

Abstract

Introduction: The relationship between arterial and venous blood flow in moderate-to-severe traumatic brain injury (TBI) is poorly understood.

The research question: was to compare differences in perfusion computed tomography (PCT)-derived arterial and venous cerebral blood flow (CBF) in moderate-to-severe TBI as an indication of changes in cerebral venous outflow patterns referenced to arterial inflow.

Material and methods: Moderate-to-severe TBI patients (women 53; men 74) underwent PCT and were stratified into 3 groups: I (moderate TBI), II (diffuse severe TBI without surgery), and III (severe TBI after the surgery). Arterial and venous CBF were measured by PCT in both the internal carotid arteries (CBFica) and the confluence of upper sagittal, transverse, and straight sinuses (CBFcs).

Results: In group I, CBFica on the left and right sides were significantly correlated with each other (p < 0.0001) and with CBFcs (p = 0.048). In group II, CBFica on the left and right sides were also correlated (P < 0.0000001) but not with CBFcs. Intracranial pressure reactivity (PRx) and CBFcs were correlated (p = 0.00014). In group III, CBFica on the side of the removed hematoma was not significantly different from the opposite CBFica (P = 0.680) and was not correlated with CBFcs.

Discussion and conclusion: The increasing severity of TBI is accompanied by a rising uncoupling between the arterial and venous CBF in the supratentorial vessels suggesting a shifting of cerebral venous outflow.

Keywords: CBF; PCT; Traumatic brain injury.

Grants and funding

R01 NS112808/NS/NINDS NIH HHS/United States