Biomedical subjects

Christopher M Quick

Publications and source records attributed to Christopher M Quick.

4 recordsLinked to original sources

PubMed2002

Adaptation of cerebral circulation to brain arteriovenous malformations increases feeding artery pressure and decreases regional hypotension.

PURPOSE: To determine how the adaptation of extranidal cerebral vessels affects feeding artery pressure, draining vein pressure, and regional hypotension due to the presence of brain arteriovenous malformations (BAVMs). CONCEPT: BAVMs cause high flows in feeding arteries and draining veins and can induce profound hypotension in the neighboring vasculature. Despite the large difference in flow, endothelial shear stress (tau) observed in vessels ipsilateral to the BAVM is similar to tau in vessels contralateral to the BAVM, suggesting that the conductance vessels successfully adapt to keep tau constant. However, because BAVMs are discovered only after they are well developed, the natural history of the adaptation process in extranidal vessels is unknown. RATIONALE: Currently, no way exists to determine experimentally the effects of adaptation of extranidal vessels in human patients. Therefore, a mathematical model of the cerebral vasculature is used to study adaptation in response to BAVMs. By comparing pressures and flows calculated before and after adaptation, the effect of adaptation of the conductance vessels on regional hemodynamics can be evaluated. DISCUSSION: Structural adaptation of the extranidal circulation seems not only to reset tau, but also to ameliorate regional hypotension induced by BAVMs. However, this compensatory mechanism also increases feeding artery pressure and thus may increase the risk of hemorrhagic stroke.

Blood Flow Velocity↗

PubMed2002

Increased cerebral blood flow after brain arteriovenous malformation resection is substantially independent of changes in cardiac output.

Brain arteriovenous malformation (BAVM) resection can result in an acute increase in cerebral blood flow (CBF) of unclear etiology. This observational study investigated the relationship between changes in CBF and cardiac output (CO) in patients undergoing microsurgical resection of BAVMs. In 20 patients undergoing a BAVM resection during an isoflurane-based anesthesia, we measured CBF and systemic cardiovascular parameters immediately before and after BAVM resection. CBF was measured on the hemisphere ipsilateral to the lesions and on the contralateral side, using intravenous cold 133Xe washout. Cardiac output was measured using thermodilution technique via a pulmonary artery catheter. There was an increase in global CBF after resection (25 +/- 8 versus 31 +/- 13 mL/100 g/min, preresection versus postresection, mean +/- SD, P =.002), ipsilateral CBF (25 +/- 8 versus 31 +/- 13 mL/100 g/min, P =.002), and contralateral CBF (24 +/- 7 versus 30 +/- 13 mL/100 g/min, P =.003). There was no change in CO, mean systemic arterial pressure, central venous pressure, or pulmonary artery diastolic pressure. The change in CBFGLOBAL was not correlated with changes in CO (r =.154, P =.517). BAVM resection resulted in global increases in CBF that was not substantially related to changes in CO or other systemic parameters.

Adult↗

PubMed2002

Arterial pulse wave reflection as feedback.

Traditionally, input impedance (Z(in)) has been used to characterize the global dynamic properties of an arterial system independent of properties of the heart. Defined as the relationship of pressure and flow at the entrance of an arterial system, it describes the ability of an arterial system to dynamically impede blood flow. Recently, a new description has been developed that also characterizes the arterial system independent of properties of the heart. Apparent arterial compliance (C(app)) is defined as the dynamic relationship of input pressure and volume stored in an arterial system, and describes the ability of the arterial system to dynamically store blood. Both Z(in) and C(app) are influenced by pulse wave propagation and reflection. However, the functional form of Capp lends itself to describing the arterial system in terms of negative feedback. Pulse wave reflection decreases the pulsatile volume stored (gain) at low frequencies, but increases the range of frequencies (bandwidth) in which the pulsatile volume is determined by total arterial compliance. This paper illustrates, by simple analytical formula, large-scale arterial system modeling, and direct analysis of data, how this conceptualization of reflection offers a new means to interpret changes in arterial system dynamics resulting from changes in arterial compliance.

Animals↗

PubMed2002

Relationship of nidal vessel radius and wall thickness to brain arteriovenous malformation hemorrhage.

Cerebral (brain) arteriovenous malformations (BAVMs) are a tangle of disorganized vessels that are a rare cause of hemorrhagic stroke in the general population. Although clinical presentation of hemorrhage may be related to the structure of BAVM vessels, there has been no systematic quantitative analysis of BAVM vessel morphology. Histological sections of excised BAVM lesions were prepared from patients who presented with hemorrhage (n = 14) and from patients with no history of hemorrhage (n = 22). Mean values of radius and wall thickness in each section were determined. BAVM radii were 422+/-136 microm (mean +/- SD), minimum wall thickness (thinnest portion of the wall) was 54+/-14 microm; and the minimum thickness/radius ratio was 0.23+/-0.07. Greater vessel wall thickness was associated with hemorrhagic presentation (OR= 1.1; p = 0.046) after adjusting for feeding artery pressure. Because BAVM vessels from patients presenting with hemorrhage had thicker vessel walls, the search for structural properties predisposing BAVM rupture should be expanded beyond the morphological properties analyzed here.

Adult↗