Subjects with hemodynamic failure stage 2 (i.e. misery-perfusion) have heightened risk of acute and chronic brain tissue damage. One of the most important signs of misery-perfusion is a negative cerebrovascular reactivity (CVR). CVR is defined as a blood flow response to a vasoactive stimulus. Recently blood-oxygenation-level-dependent (BOLD) CVR was proposed to detect misery-perfusion. However, BOLD-CVR MRI signal does not reflect CBF changes directly and discrepancies between negative BOLD-CVR and negative CBF changes have been reported. To better assess these discrepancies, we performed a multimodal clinical misery-perfusion assessment with perfusion-weighted-MRI and transcranial-Doppler complimentary to BOLD-CVR in patients with symptomatic steno-occlusive disease.
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