Selective neuronal loss progression in chronic carotid or middle cerebral artery obstruction is accentuated by lower follow-up systolic blood pressure

In the paper by Yamauchi et al 1, the authors tested the hypothesis that in chronic significant atherosclerotic stenosis or occlusion of the internal carotid artery (ICA) or middle cerebral artery (MCA), the lower the systemic blood pressure (BP) at follow-up, the more severe the progression of ipsilateral selective neuronal loss (SNL). Previous work by the same group has documented that chronic haemodynamic ICA/MCA obstruction causes progressive ipsilateral SNL2 (see also Baron et al 3 for review) associated with a decline in cognitive functions.4 The assumption behind the author’s hypothesis is that in this clinical scenario, SNL is triggered by persistent ipsilateral chronic hypoperfusion and hypoxia, with superimposed intermittent BP drops killing additional neurons without overt acute symptoms. To test their hypothesis, they obtained in 79 medically treated …