Hemodynamic examination by transcranial Doppler in patients with unilateral carotid artery occlusion
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Objective To explore the relationship between the changing of peak blood velocity and pulsatility index in the side of internal carotid artery occlusion with opening of Willis circle and intra-(extracranial) arterial communication.Methods This study group includes 112 patients with extracranial segments of internal carotid arterial occlusion in one side and the other side normal or stenosis less than 50%,and 112 control patients without cerebrovascular disease and both extracranial and intracranial segment of internal carotid arteries were normal by color Doppler flow imaging.The peak systolic velocity(PSV) and pulsatility index(PI) of the bilateral middle cerebral artery(MCA),anterior cerebral artery(ACA) and posterior cerebral artery(PCA) were measured,the difference of PSV and PI of bilateral MCA,ACA,PCA in the occlusion group and control group were compared respectively.The PSV difference(PSVD) and PI difference(PID) of the occluded side were counted.Results The PSVD and PID of bilateral MCA in occlusion group were significantly higher than control group(PSVD(61 cm/s),P=0.000;(PID)70%,P=0.000).There was obviously asymmetry between bilateral MCA,ACA,and PCA in occlusion group.The PSV and PI of MCA and ACA in the occluded side were significantly lower than the normal side(P=0.000).The PSV of PCA in the occuded side was significantly higher and the PI was significantly lower than normal side((P=)0.000 respectively).PSV of MCA in the occluded side correlated with bilateral ACA and PCA(P=0.000,(P=)0.000,(P=)0.006 respectively).(Conclusion) Aggregate analysis of PSV and PI,and PSVD and PID in bilateral MCA by TCD will increase recognition of abnormal hemodynamic in the patients with unilateral internal carotid occlusion.Keywords:
Circle of Willis
Posterior cerebral artery
Anterior cerebral artery
Transcranial Doppler
Posterior communicating artery
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We studied TCD findings in six patients with occlusion of the internal carotid artery (ICA), including two with bilateral ICA occlusion. Their ages ranged from 60 to 70 yr with mean of 64 yr. All patients had superficial temporal artery-middle cerebral artery (STA-MCA) bypass. Mean flow velocity (MFV) and pulsatility index (PI) in the middle cerebral artery (MCA), anterior cerebral artery (ACA) and STA were measured pre-and postoperatively. Two of three patients demonstrated a decrease of MFV and a slight increase of PI in the MCA postoperatively. All three showed decreased MFV in the ACA after surgery. Five patients demonstrated a significant increase of MFV and a decrease of PI in the STA after the procedure.These results indicate that TCD is clinically useful for assessing hemodynamic changes induced by bypass surgery.
Superficial temporal artery
Pulsatility index
Transcranial Doppler
External carotid artery
Anterior cerebral artery
Bypass surgery
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Objective: Analysis and study of transcranial Doppler in patients with depression(TCD) detection index,provides the reference for the clinical treatment of.Methods: In our hospital in 2011 October-2012 year in October of 120 patients with depression,as observation group,compared with 120 healthy men as control group,underwent transcranial Doppler detection,compared two groups of bilateral middle cerebral artery(MCA),anterior cerebral artery(ACA),posterior cerebral artery(PCA),vertebral basilar artery(VA-BA),blood flow velocity and pulsatility index.Results: The observation group of patients with bilateral middle cerebral artery(MCA),anterior cerebral artery(ACA) and posterior cerebral artery(PCA) blood flow velocity was significantly higher than that of the control group,while the vertebrobasilar artery(VA-BA) blood flow velocity was significantly lower than that of the control group,the difference between groups was significant(p0.05);the control group and the observation group artery patients with bilateral middle cerebral(MCA),anterior cerebral artery(ACA),posterior cerebral artery(PCA),vertebrobasilar artery pulsatility index(VA-BA) were in the normal range(0.6-1.0).Conclusion: Transcranial Doppler detection of cerebral blood flow in patients with depression than in normal human brain blood flow significantly slow,cerebral blood flow changes of transcranial Doppler monitoring of patients with depression,can be used as a routine examination in patients with depression,and provide the basis for the diagnosis and treatment of clinical.
Transcranial Doppler
Posterior cerebral artery
Anterior cerebral artery
Depression
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Objective To investigate the significance of hemodynamic changes of anterior and posterior cerebral arteries for diagnosing moderate or severe stenosis of the middle cerebral artery (MCA) by transcranial Doppler (TCD).Methods A Total of 75 patients with unilateral moderate (n = 19) and severe (n=56) stenosis of MCA were confirmed by DSA examination.TCD was used to detect the peak systolic velocity (PSV) , end diastolic velocity (EDV) , and PSV distal to stenosis (PSV_(dis)) of the bilateral MCA, anterior cerebral artery (ACA) , and posterior cerebral artery (PCA).The pulsatility index (PI) and the ratio between the stenotic segment of MCA and PSV/PSV_(dis) were calculated.The compensational conditions of ACA and PCA meningeal branches showed on DSA were recorded.Results ① Meningeal branch compensation was not found in 19 patients with moderate stenosis; of the 56 patients with severe stenosis, 31 had meningeal branch compensation, 18 had ACA meningeal branch compensation, and 24 had PCA meningeal branch compensation (P = 0.263).② PSV and PSV/PSV_(dis) of MCA in patients with severe stenosis were significantly higher than those of moderate stenosis (P 0.01).On the ipsilateral side of the patients with severe stenosis, PSV (126 ±51 and 85 ±35 cm/s) and EDV (61 ±30 s and 41 ± 21cm/s) of ACA and PCA were significantly higher than PVS (102 ±32 and 61 ± 13 cm/s) and EDV (47 ± 17 and 28 ±7 cm/s) of ACA and PCA on the contralateral side (P 0.01) ; There were no significant differences in PSV and EDV of bilateral ACA and PCA in patients with moderate stenosis (P0.05).③ PSV and EDV of the patients with ACA and PCA meningeal branch compensation were significantly faster than those without compensation (P 0.01) , and the PI value decreased (P 0.05).Conclusion TCD showed the increased flow velocity compensation in ipsilateral ACA and PCA, and it has important diagnostic value for identifying moderate or severe stenosis of MCA.
Transcranial Doppler
Anterior cerebral artery
Posterior cerebral artery
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Objective To analyze the detective rate and accuracy of hemodynamic changes of chronic middle cerebral artery occlusion(MCAO) detected by transcranial Doppler sonography(TCD).Methods 32 patients confirmed by digital subtraction angiography(DSA) and magnetic resonance angiography(MRA) were detected by TCD to collect systolic peak velocity(SPV),pulsatility indices(PI) in symptomatic middle(MCA),anterior(ACA),posterior(PCA),and in affected(a),ipsilateral(i),and contralateral(c-lat) cerebral arterial.Results ①The SPV of affected MCA was significantly lower than that of contralateral MCA,ispilatera ACA and PCA.② Ratios of aMCA /c-lat MCA,aMCA /iACA,and aMCA /iPCA were 0.559,0.541,0.797,respectively.③In chronic MCAO,the SPV of affected MCA ranged from 30 to 85 cm/s.TCD showed that 64.5% of chronic MCAO patients had a SPV lower than 70 cm/s in the affected MCA.④The PI of ipsilateral ACA,PCA and contralateral PCA in M1 MCAO patients were significantly lower than those in M2 MCAO patients.However,no significant differences were found in SPV of the affected MCA between them.Conclusions To enhance the recognition of hemodynamic changes of intracranial circulation in MCAO patients can increase diagnosis accuracy.
Transcranial Doppler
Digital subtraction angiography
Anterior cerebral artery
Magnetic resonance angiography
Posterior cerebral artery
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Neurologic deficits that occur simultaneously with or subsequent to internal carotid artery occlusion may be influenced by the adequacy of the intracerebral collateral circulation. Transcranial Doppler ultrasonography was used to evaluate mean middle cerebral artery blood velocity and blood flow in major collateral arteries in 78 patients, including 39 patients with 40 internal carotid artery occlusions and 39 control patients with less severe extracranial cerebrovascular disease, matched for age and sex distribution. Middle cerebral artery blood velocity was 38.9 +/- 17.9 cm/sec ipsilateral to an occlusion, 50.9 +/- 18.3 cm/sec contralateral to an occlusion (p less than 0.01), and 56.8 +/- 14.4 cm/sec in the controls (p less than 0.01). Pulsatility index ipsilateral to an occlusion (0.86 +/- 0.32) was reduced compared with contralateral and control pulsatility indexes (1.05 +/- 0.33 and 1.03 +/- 0.18) respectively; p less than 0.05). Major intracerebral collateral arteries were detectable in 94.9% of occlusion patients and in 53.8% of controls (p less than 0.01). A posterior communicating artery was demonstrated ipsilateral to an occlusion in 80.0% of the patients and contralateral to an occlusion in 39.5% (p less than 0.01). An ipsilateral posterior communicating artery was identified in all 10 asymptomatic occlusions and in 75.8% of the symptomatic ones. Pulsatility index was 1.02 +/- 0.34 for asymptomatic occlusions and 0.76 +/- 0.30 for symptomatic occlusions (p less than 0.01). Transcranial Doppler ultrasonography permits noninvasive quantification of the cerebral hemodynamic consequences of internal carotid artery occlusion and direct evaluation of the collateral blood supply, which can be correlated with symptomatology.
Collateral circulation
Posterior communicating artery
Transcranial Doppler
Posterior cerebral artery
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The authors performed transcranial Doppler ultrasonography (TCD) during internal carotid artery (ICA) balloon test occlusion (BTO) and observed changes in mean flow velocity (Vm) in the middle cerebral artery (MCA), and pulsatility index (PI) while monitoring the stump pressure (Sp) of the internal carotid artery (ICA), and neurologic findings. A group of 17 patients requiring possible temporary or permanent occlusion of the ICA in the course of planned procedures first underwent BTO. A patient who either developed neurologic changes or maintained less than 60% of preocclusion Sp or Vm in the ipsilateral MCA during BTO was considered to have a positive test. Eleven patients had negative results, while in six patients, tests were positive. Mean flow velocity showed a decrease after occlusion in all cases but not to a remarkable extent in some patients. Stump pressure decreased in all negative cases after balloon inflation and than tended to increase progressively during 15 minutes of BTO. Pulsatility index tended to decrease gradually during BTO in all negative patients. However, in positive cases, PI and Sp fell steeply. Only one positive case had a neurologic symptom of severe headache. The decreased PI in the MCA reflected autoregulatory dilation of cerebral vessels to compensate for decreased absolute cerebral blood volume following ICA occlusion. Changes in PI are a good indicator for evaluating blood flow during BTO.
Transcranial Doppler
Anterior cerebral artery
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Neuroradiology
Stroke
Magnetic resonance angiography
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Objective To study how to prevent cerebral ischemia and hyperperfusion syndrome during carotid endarterectomy (CEA).Methods Twenty-ninth cases of patients undergoing CEA (35 procedures in total) with carotid artery stenosis were divided into bilateral (group A) and unilateral (group B) stenosis groups.During CEA,the regulation of blood pressure was according to the changes of the ipsilateral middle cerebral artery mean flow velocity (MCA Vm) detected by transcranial Doppler (TCD):if the MCA Vm after carotid artery occlusion was lower than 70％ of that before occlusion,the blood pressure should be increased; and if the MCA Vm after release cross was higher than 100％ of that before carotid artery occlusion,the blood pressure should be decreased.All cases in the study were underwent transcranial Doppler,color Doppler flow imaging,CT angiography,CT perfusion imaging,Magnetic resonance imaging,and/or digital subtraction angiography before and after surgery.Results (1) In the two groups:the MCA Vm of the intraoperation side before carotid artery occlusion was decreased as compared with that before anesthesia (P =0.000).After carotid artery occlusion,the MCA Vm was decreased slightly as compared with that before occlusion (P ＞ 0.05),and the blood pressure was increased (23.76 ±9.15)％ (P =0.000) ; The MCA Vm after release cross was higher than that before occlusion(P =0.000),the blood pressure was decreased (6.70 ±6.89)％ (P =0.000).(2) Between the two groups:After carotid artery occlusion,the MCA Vm of the intraoperation side in group B was decreased than that in group A (P ＜ 0.05).The enhance rate of the blood pressure was higher than that in group A(P ＜0.01).After release cross,the reduce rate of the blood pressure in group B was lower than that group A (P ＜ 0.05).The MCA Vm between the two groups had no statistic difference (P ＞ 0.05).(3) After surgery,the cerebral perfusion of all patients of the intraoperation side was improved versus that before surgery.Conclusion During CEA,TCD could real-time monitor the changes of cerebral hemodynamics,evaluate the cerebral perfusion,guide the to regulate the blood pressure timely,so as to improve the success rate of surgery significantly.
Key words:
Ultrasonography, Doppler, transcranial ; Carotid stenosis ; Carotid endarterectomy; Cerebral hemodynamics
Transcranial Doppler
Digital subtraction angiography
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Seventeen patients, 14 males and 3 females, mean age 64 years (range 45-77 years) with longstanding unilateral occlusion of the internal carotid artery and minimal neurological deficit, were evaluated in order to find criteria for potential benefit of extracranial-intracranial by-pass surgery. 3-D transcranial Doppler was used for estimation of mean velocities and pulsatility index in the middle cerebral artery, anterior cerebral artery and posterior cerebral artery before and after iv injection of 1 g acetazolamide. The anterior cerebral artery was the supplying vessel to the occluded side in 16 patients and mean velocities were significantly (p < 0.001) faster on the occluded (59.3 +/- 14.5 cm sec-1) and nonoccluded (91.6 +/- 29.6 cm sec-1, p < 0.05)) side than those found in the middle cerebral artery (39.2 +/- 13.7 and 50.9 +/- 8.5 cm sec-1). In two patients a decrease of mean velocity after acetazolamide was noted in middle cerebral artery indicating 'steal' effect. In another 4 patients, poor vasomotor response was seen with less than 11% of mean velocity increase in the middle cerebral artery. Differences between posterior cerebral artery on the occluded and nonoccluded side were insignificant as well as those between middle and posterior on the occluded side. Resting values of pulsatility index differed significantly (p < 0.01) only between anterior and posterior cerebral artery on the nonoccluded side.(ABSTRACT TRUNCATED AT 250 WORDS)
Posterior cerebral artery
Anterior cerebral artery
Acetazolamide
Transcranial Doppler
Posterior communicating artery
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Objective
To analyze the hemodynamic changes of cerebral arterial collateral circulation and distal perfusion of cerebral arteries after external carotid artery occlusion (EICAO).
Methods
Ninety-six patients with EICAO were selected as the case group, of which 46 cases of left EICAO (group A), 50 cases of right EICAO (group B) and 30 normal volunteers were selected as the control group.Color Doppler ultrasonography (TCD) was used to detect peak systolic velocity (Vs) in the middle cerebral artery (MCA), end diastolic velocity (Vd), mean blood flow velocity (Vm), pulsatility index (PI), hemodynamic parameters of arteries, and opening rate of grade I anterior communicating artery (ACOA) and posterior communicating artery (PCOA).
Results
There were significant differences in Vs, Vm, Vd, and PI among group A, B and C (F=56.046, 31.027, 39.283, 18.614, 49.658, 24.992, 15.035, 22.069, P<0.001). The Vs, Vd, Vm, and PI of the left MCA in the group A were significantly lower than those of the left side in the control group (P<0.01); the Vs, Vd, Vm, and PI of the right MCA in the group B were significantly lower than those of the right side in the control group (P<0.01). In group A and B, the open rate of simple ACOA in the stage I collateral circulation was 26.09% and 30.00%.The open rate of PCOA alone was 23.91% and 36.00%, respectively, and the concurrent opening rate of ACOA and PCOA was 36.96% and 30.00%, respectively, There was no significant difference in the open rate of grade I collateral circulation among the three types of blood vessels (χ2=0.223, 2.881, 0.808, P=0.637, 0.090, 0.369). The incidence of cerebral infarction at the MCA donor site in the group A was 60.87% on the left side and 8.70% on the right side.The data of the left side was significantly higher than that of the right side (χ2=57.165, P<0.001). The incidence of cerebral infarction at the MCA in the group B was 14.00% on the left side and 60.00% on the right side, and the data of the right side was significantly higher than that of the left side (χ2=43.436, P<0.001).
Conclusion
Although there is a higher grade I collateral circulation opening rate in patients with EICAO, the MCA blood supply area of the distal internal carotid artery is still in a state of low blood flow perfusion, and the incidence of cerebral infarction is also high, so opening the grade I collateral circulation does not completely reduce the risk of cerebral infarction in these patients, and these patients are still at high risk of cerebral infarction.
Key words:
Internal carotid artery; Occlusion; Hemodynamic; Compensatory circulation; Compensation response
Collateral circulation
Anterior cerebral artery
Posterior communicating artery
Anterior communicating artery
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