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The purpose of this study was to assess spatially remote effects of hemodynamic impairment on functional network topology contralateral to unilateral anterior circulation steno-occlusive disease (SOD) using resting-state blood oxygen level-dependent (BOLD) imaging, and to investigate the relationships between network connectivity and cerebrovascular reactivity (CVR), a measure of hemodynamic stress. Twenty patients with unilateral, chronic anterior circulation SOD and 20 age-matched healthy controls underwent resting-state BOLD imaging. Five-minute standardized baseline BOLD acquisition was followed by acetazolamide infusion to measure CVR. The BOLD baseline was used to analyze network connectivity contralateral to the diseased hemispheres of SOD patients. Compared to healthy controls, reduced network degree ( z -score = −1.158 ± 1.217,  P  &amp;lt; 0.001, false discovery rate (FDR) corrected), local efficiency ( z -score = −1.213 ± 1.120,  P  &amp;lt; 0.001, FDR corrected), global efficiency ( z -score = −1.346 ± 1.119,  P  &amp;lt; 0.001, FDR corrected), and enhanced modularity ( z -score = 1.000 ± 1.205,  P  = 0.002, FDR corrected) were observed in the contralateral, normal hemispheres of SOD patients. Network degree ( P  = 0.089, FDR corrected;  P  = 0.027, uncorrected) and nodal efficiency ( P  = 0.089, FDR corrected;  P  = 0.045, uncorrected) showed a trend toward a positive association with CVR. The results indicate remote abnormalities in functional connectivity contralateral to the diseased hemispheres in patients with unilateral SOD, despite the absence of macrovascular disease or demonstrable hemodynamic impairment. The clinical impact of remote functional disruptions requires dedicated investigation but may portend far reaching consequence for even putatively unilateral cerebrovascular disease.

frontiers in neurology

Alterations in Functional Network Topology Within Normal Hemispheres Contralateral to Anterior Circulation Steno-Occlusive Disease: A Resting-State BOLD Study