Neurovascular Uncoupling Is Linked to Microcirculatory Dysfunction in Regions Outside the Ischemic Core Following Ischemic Stroke

BACKGROUND: Normal brain function depends on the ability of the vasculature to increase blood flow to regions with high metabolic demands. Impaired neurovascular coupling, such as the local hyperemic response to neuronal activity, may contribute to poor neurological outcome after stroke despite successful recanalization, that is, futile recanalization. METHODS AND RESULTS: Mice implanted with chronic cranial windows were trained for awake head‐fixation before experiments. One‐hour occlusion of the anterior middle cerebral artery branch was induced using single‐vessel photothrombosis. Cerebral perfusion and neurovascular coupling were assessed by optical coherence tomography and laser speckle contrast imaging. Capillaries and pericytes were studied in perfusion‐fixed tissue by labeling lectin and platelet‐derived growth factor receptor β. Arterial occlusion induced multiple spreading depolarizations over 1 hour associated with substantially reduced blood flow in the peri‐ischemic cortex. Approximately half of the capillaries in the peri‐ischemic area were no longer perfused at the 3‐ and 24‐hour follow‐up (45% [95% CI, 33%–58%] and 53% [95% CI, 39%–66%] reduction, respectively; P<0.0001), which was associated with contraction of an equivalent proportion of peri‐ischemic capillary pericytes. The capillaries in the peri‐ischemic cortex that remained perfused showed increased point prevalence of dynamic flow stalling (0.5% [95% CI, 0.2%–0.7%] at baseline, 5.1% [95% CI, 3.2%–6.5%] and 3.2% [95% CI, 1.1%–5.3%] at 3‐ and 24‐hour follow‐up, respectively; P=0.001). Whisker stimulation at the 3‐ and 24‐hour follow‐up led to reduced neurovascular coupling responses in the sensory cortex corresponding to the peri‐ischemic region compared with that observed at baseline. CONCLUSIONS: Arterial occlusion led to contraction of capillary pericytes and capillary flow stalling in the peri‐ischemic cortex. Capillary dysfunction was associated with neurovascular uncoupling. Neurovascular coupling impairment associated with capillary dysfunction may be a mechanism that contributes to futile recanalization. Hence, the results from this study suggest a novel treatment target to improve neurological outcome after stroke.