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Semin Thromb Hemost
DOI: 10.1055/s-0043-1775858
Review Article

Whole Blood Viscosity and Cerebral Blood Flow in Acute Ischemic Stroke

Prajwal Gyawali
1   Heart and Stroke Program, Hunter Medical Research Institute and School of Health and Medical Sciences, University of Southern Queensland, Toowoomba, Queensland, Australia
,
Thomas P. Lillicrap
2   Heart and Stroke Program, Department of Neurology, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
,
Carlos G. Esperon
2   Heart and Stroke Program, Department of Neurology, Hunter Medical Research Institute, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
,
Aseem Bhattarai
3   Department of Biochemistry, Institute of Medicine, Kathmandu, Nepal
,
Andrew Bivard
4   Department of Neurology, Royal Melbourne Hospital, Parkville, Victoria, Australia
,
Neil Spratt
5   Heart and Stroke Program, Department of Neurology, Hunter Medical Research Institute, School of Biomedical Sciences and Pharmacy, University of Newcastle, John Hunter Hospital, New Lambton Heights, New South Wales, Australia
› Author Affiliations Funding N.S. was supported by the New South Wales Health Cardiovascular Research Capacity Program, Senior Researcher Grant (H20/28248).
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Abstract

Existing effective treatments for ischemic stroke restore blood supply to the ischemic region using thrombolysis or mechanical removal of clot. However, it is increasingly recognized that successful removal of occlusive thrombus from the large artery—recanalization, may not always be accompanied by successful restoration of blood flow to the downstream tissues—reperfusion. Ultimately, brain tissue survival depends on cerebral perfusion, and a functioning microcirculation. Because capillary diameter is often equal to or smaller than an erythrocyte, microcirculation is largely dependent on erythrocyte rheological (hemorheological) factors such as whole blood viscosity (WBV). Several studies in the past have demonstrated elevated WBV in stroke compared with healthy controls. Also, elevated WBV has shown to be an independent risk factor for stroke. Elevated WBV leads to endothelial dysfunction, decreases nitric oxide-dependent flow-mediated vasodilation, and promotes hemostatic alterations/thrombosis, all leading to microcirculation sludging. Compromised microcirculation further leads to decreased cerebral perfusion. Hence, modulating WBV through pharmacological agents might be beneficial to improve cerebral perfusion in stroke. This review discusses the effect of elevated WBV on endothelial function, hemostatic alterations, and thrombosis leading to reduced cerebral perfusion in stroke.

Keywords

acute ischemic stroke - whole blood viscosity - cerebral perfusion - microcirculation


Publication History

Article published online:
09 October 2023

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