Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Review
. 2018 Jan;24(1):5-17.
doi: 10.1111/cns.12780. Epub 2017 Nov 15.

Advances in chronic cerebral circulation insufficiency

Da Zhou  1   2   3 , Ran Meng  1   2   3 , Si-Jie Li  1   2 , Jing-Yuan Ya  1   2   3 , Jia-Yue Ding  1   2   3 , Shu-Ling Shang  1 , Yu-Chuan Ding  3   4 , Xun-Ming Ji  1   2   3
Affiliations
Review

Advances in chronic cerebral circulation insufficiency

Da Zhou et al. CNS Neurosci Ther. 2018 Jan.

Abstract

Chronic cerebral circulation insufficiency (CCCI) may not be an independent disease; rather, it is a pervasive state of long-term cerebral blood flow insufficiency caused by a variety of etiologies, and considered to be associated with either occurrence or recurrence of ischemic stroke, vascular cognitive impairment, and development of vascular dementia, resulting in disability and mortality worldwide. This review summarizes the features and recent progress of CCCI, mainly focusing on epidemiology, experimental research, pathophysiology, etiology, clinical manifestations, imaging presentation, diagnosis, and potential therapeutic regimens. Some research directions are briefly discussed as well.

Keywords: chronic cerebral circulation insufficiency; clinical manifestation; diagnosis; experimental research; treatment.

PubMed Disclaimer

Conflict of interest statement

All authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Atherosclerotic stenosis–associated chronic cerebral circulation insufficiency. The classification, subtypes, and clinical consequences of intracranial and extracranial atherosclerotic stenosis–associated cerebral circulation insufficiency
Figure 2
Figure 2
Severity of vascular stenosis, CBF reduction, and degree of neuronal damage. CCCI runs through the whole process of TIA/stroke. CBF around 50‐55ml/100 g brain tissue/min: normal; CBF <40 mL/100 g brain tissue/min: disruption of glucose utilization initiates; CBF <30 mL/100 g brain tissue/min: protein synthesis disorder occurs; reduction in CBF to 10‐25 mL/100 g brain tissue/min: neuronal activity becomes invalid and symptoms of neurological dysfunctions appear; CBF goes below 8 mL/100 g brain tissue/min: cell membrane failure occurs, followed by irreversible nerve damage or cell death. CCCI: chronic cerebral circulation insufficiency; TIA: transient ischemic stroke; CBF: cerebral blood flow
Figure 3
Figure 3
Proposed pathological mechanisms resulting from chronic cerebral circulation insufficiency
Figure 4
Figure 4
Imaging modalities for CCCI evaluation. A, SPECT reveals mild anterior circulation hypoperfusion in the left middle cerebral artery (L‐MCA) territory (red arrows). B, CTP maps indicate remarkable hypoperfusion in the left hemisphere, with decreased CBF, increased CBV, prolonged MTT and TTP. C, MRA shows L‐MCA occlusion; DWI shows an area of restricted diffusion (ischemic brain lesion) in the territory of L‐MCA; PWI shows that the hypoperfusion area is larger than that in DWI, this diffusion/perfusion mismatch suggests the presence of ischemic penumbra. CCCI: chronic cerebral circulation insufficiency; SPECT: single‐photon emission computed tomography; CTP: computed tomography perfusion; CBF: cerebral blood flow; CBV: cerebral blood volume; MTT: mean transit time; TTP: time to peak; MRA: magnetic resonance angiography; DWI: diffusion‐weighted MR; PWI: perfusion‐weighted MR
See this image and copyright information in PMC

References

    1. Wu C, Liao L, Yan X, et al. Effects of Yangxue Qingnao Granules on chronic cerebral circulation insufficiency: a randomized, double‐blind, double‐dummy, controlled multicentre trial. Psychogeriatrics. 2013;13:29‐34. - PubMed
    1. Safouris A, Hambye AS, Sculier C, et al. Chronic brain hypoperfusion due to multi‐vessel extracranial atherosclerotic disease: a potentially reversible cause of cognitive impairment. J Alzheimers Dis. 2015;43:23‐27. - PubMed
    1. Wang Y, Zhao X, Liu L, et al. Prevalence and outcomes of symptomatic intracranial large artery stenoses and occlusions in China: the Chinese Intracranial Atherosclerosis (CICAS) Study. Stroke. 2014;45:663‐669. - PubMed
    1. Calabrese V, Giordano J, Signorile A, et al. Major pathogenic mechanisms in vascular dementia: roles of cellular stress response and hormesis in neuroprotection. J Neurosci Res. 2016;94:1588‐1603. - PubMed
    1. Sarti C, Pantoni L, Bartolini L, Inzitari D. Cognitive impairment and chronic cerebral hypoperfusion: what can be learned from experimental models. J Neurol Sci. 2002;203–204:263‐266. - PubMed

MeSH terms