Biomedical Engineering Reference
In-Depth Information
and vascular endothelial cells. h e involvement of leukocytes at the capillary level is
particularly important and interaction with ICAM-1 reinforces adhesion, leading
to occlusion of microvessels and the formation of microthrombosis. In these parts,
there is also an increase in microvessel permeability and endothelial dysfunction
develops from disruption of the BBB. h ese changes play an important role in the
pathogenesis of SVD with lacunar infarctions and WMLs. It is necessary to target
therapy on the vascular endothelium in order to prevent the development and
progression of SVD and it is likely that
combination therapy with drugs that protect
the vessel endothelium, like cilostazol, rennin-angiotensin system inhibitors and
statins, would be useful.
SUMMARY
• Brain ischemia induces expression of inl ammatory mediators in vascular
endothelial cells, which increases the expression of adhesion molecules
and enhances interaction between leukocytes and the endothelial cells.
• As an important factor in the no-rel ow phenomenon occurring at er
ischemia and reperfusion, the involvement of leukocytes at the capillary
level has received attention.
• Endothelial dysfunction in microvessels is thought to play an important role
in the pathogenesis of cerebral small-vessel disease and its progression.
• Vascular risk factors such as hypertension, diabetes, and smoking decrease
the production of nitric oxide and facilitate the progression of endothelial
dysfunction.
• It is necessary to target therapy on the vascular endothelium in order to
prevent the development and progression of cerebral small-vessel disease
and it is likely that combination therapy with drugs having protection of
the vessel endothelium would be useful.
Abbreviations
AMs
adhesion molecules
BBB
blood brain barrier
hs-CRP
high-sensitivity C-reactive protein
MRI
magnetic resonance imaging
SBI
silent brain infarction
sICAM-1
soluble intercellular adhesion molecule 1
sVCAM-1
soluble vascular cell adhesion molecule 1
SVD
small-vessel disease
TNF-α
tumor necrosis factor α
WMLs
white matter lesions
