Сompensatory reactions of cerebral blood flow to stenosis of the internal jugular veins: results of ultrasound scanning and transcranial doppler

Introduction: When studying the venous-arterial balance of blood flow at the neck level with unilateral stenosis of the internal jugular veins, a strong significant relationship was registered between a decrease in the total values of the outflow of venous blood to the internal jugular veins and a decrease in the total values of arterial inflow through the common carotid and vertebral arteries. Considering the controversial assumption of possible reflex constriction of the main arteries of the neck, this study was undertaken.

Objective: The purpose of the study was to study the adaptive-compensatory manifestations of extra- and intracranial main blood flow and cerebrovascular (venous-arterial) imbalance in stenosis of the internal jugular veins using US and TСD.

Materials and Methods: The study included data from 114 people (50 with extrinsic compression stenosis, 27 with hypoplasia, 6 after ligation/removal of the internal jugular veins on one side and 31 in the control group). The ranking assessment of the clinical condition consisted of determining the sum of syndromes in the clinical picture of cerebral venous congestion, which is a component of idiopathic (isolated) intracranial hypertension (cephalgia, neurological deficit, epilepsy, vestibular disorders, asthenic syndrome). An ultrasound study was performed to determine the cross-sectional area, time-averaged blood flow velocity in the internal jugular, common carotid and vertebral arteries with subsequent calculation of volumetric inflow and outflow, an indicator of venous-arterial balance. Transcranial Doppler was performed to determine peak blood flow velocities in the middle cerebral arteries, straight sinus, and basal veins of Rosenthal with the determination of resistance indices and cerebrovascular reactivity (hypercapnic test) of the middle cerebral artery.

Statistics: Statistical calculations were performed in STATISTICA 10.0 (StatSoft, Inc.). Descriptive statistics are presented as M±sd. The normality of data distribution was assessed using the Shapiro-Wilk test. The Kruskal-Wallis test was used to compare three independent groups. Comparisons between two independent groups were performed using the Student’s T test or the MannWhitney U test. Spearman’s rank correlation coefficient was used to assess the relationship between quantitative variables.

Results: An increase in blood flow velocity in the straight sinus (on average 26,37±0,88 cm/s) and a decrease in arterial inflow in the common carotid and vertebral arteries (48,05±8,99 ml/s) with a direct strong correlation (r=0,77) were found, due mainly to a decrease in the time-averaged blood flow velocity in the CCA (46–47 cm/s on average) from the average strong correlation r=0,4–0,48. Changes in other indicators are not reliable.

Discussion: Obstruction of venous outflow leads to intracranial venous stagnation, hypoxia and hypercapnia occur, which provoke a narrowing of both intracranial arteries and large arteries of the neck (unloading reflexes). This leads to a limitation of arterial inflow, which should ultimately provide compensation for moderate disturbances of cerebral venous outflow associated with stenosis of one of the internal jugular veins.

Conclusion: These changes are likely due to a neurogenic mechanism that regulates cerebral blood flow, depending on the functioning of the baroreflex to maintain vascular resistance and reactivity of medium and large arteries in response to an increase in perfusion volume when outflow is obstructed.

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