Abstract
Introduction
Cerebral vasospasm is a complex disease resulting in reversible narrowing of blood
vessels, stroke, and poor patient outcomes. Sympathetic perivascular nerve fibers
originate from the superior cervical ganglion (SCG) to innervate the cerebral vasculature,
with activation resulting in vasoconstriction. Sympathetic pathways are thought to
be a significant contributor to cerebral vasospasm.
Objective
We sought to demonstrate that stimulation of SCG in swine can cause ipsilateral cerebral
perfusion deficit similar to that of significant human cerebral vasospasm. Furthermore,
we aimed to show that inhibition of SCG can block the effects of sympathetic-mediated
cerebral hypoperfusion.
Methods
SCG were surgically identified in 15 swine and were electrically stimulated to achieve
sympathetic activation. CT perfusion scans were performed to assess for changes in
cerebral blood flow (CBF), cerebral blood volume (CBV), mean transit time (MTT) and
time-to-maximum (TMax). Syngo.via software was used to determine regions of interest
and quantify perfusion measures.
Results
SCG stimulation resulted in 20–30% reduction in mean ipsilateral CBF compared to its
contralateral unaffected side (p < 0.001). Similar results of hypoperfusion were seen
with CBV, MTT and TMax with SCG stimulation. Prior injection of lidocaine to SCG inhibited
the effects of SCG stimulation and restored perfusion comparable to baseline (p > 0.05).
Conclusion
In swine, SCG stimulation resulted in significant cerebral perfusion deficit, and
this was inhibited by prior local anesthetic injection into the SCG. Inhibiting sympathetic
activation by targeting the SCG may be an effective treatment for sympathetic mediated
cerebral hypoperfusion.
Abbreviations:
CBF (cerebral blood flow), CBV (cerebral blood volume), CTp (computed tomography perfusion), MTT (mean transit time), SCG (superior cervical ganglion), TMax (time to maximum)Keywords
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Article Info
Publication History
Published online: May 06, 2022
Accepted:
May 4,
2022
Received in revised form:
April 14,
2022
Received:
December 29,
2021
Identification
Copyright
© 2022 Elsevier B.V. All rights reserved.
