Impact of Asymmetric Middle Cerebral Artery Velocity on Functional Recovery in Patients with Transient Ischemic Attack or Acute Ischemic Stroke
2
조회
0
다운로드
0
인용
0
참고문헌
키워드
초록
This study examined whether the difference in the middle cerebral artery (MCA) velocities can predict the prognosis of stroke and whether the prognostic impact differs among stroke subtypes. Transient ischemic attack (TIA) or acute ischemic stroke patients, who underwent a routine evaluation and transcranial Doppler (TCD), were included in this study. The MCA asymmetry index was calculated using the relative percentage difference in the mean flow velocity (MFV) between the left and right MCA: (|RMCA MFV-LMCA MFV|/mean MCA MFV)×100. The stroke subtypes were determined using the TOAST classification. Poor functional outcomes were defined as a mRS score ≥3 at 3 months after the onset of stroke. A total of 988 patients were included, of whom 157 (15.9%) had a poor functional outcome. Multivariable analysis showed that only the MCA asymmetry index was independently associated with a poor functional outcome. ROC curve analysis showed that adding the MCA asymmetry index to the prediction model improved the discrimination of a poor functional outcome from acute ischemic stroke (from 88.6% [95% CI, 85.2 ∼91.9] to 89.2% [95% CI, 85.9∼92.5]). The MCA asymmetry index has an independent prognostic value for predicting a poor short-term functional outcome after an acute cerebral infarction. Therefore, TCD may be useful for predicting a poor functional outcome in patients with acute ischemic stroke.
Abstract
This study examined whether the difference in the middle cerebral artery (MCA) velocities can predict the prognosis of stroke and whether the prognostic impact differs among stroke subtypes. Transient ischemic attack (TIA) or acute ischemic stroke patients, who underwent a routine evaluation and transcranial Doppler (TCD), were included in this study. The MCA asymmetry index was calculated using the relative percentage difference in the mean flow velocity (MFV) between the left and right MCA: (|RMCA MFV-LMCA MFV|/mean MCA MFV)×100. The stroke subtypes were determined using the TOAST classification. Poor functional outcomes were defined as a mRS score ≥3 at 3 months after the onset of stroke. A total of 988 patients were included, of whom 157 (15.9%) had a poor functional outcome. Multivariable analysis showed that only the MCA asymmetry index was independently associated with a poor functional outcome. ROC curve analysis showed that adding the MCA asymmetry index to the prediction model improved the discrimination of a poor functional outcome from acute ischemic stroke (from 88.6% [95% CI, 85.2 ∼91.9] to 89.2% [95% CI, 85.9∼92.5]). The MCA asymmetry index has an independent prognostic value for predicting a poor short-term functional outcome after an acute cerebral infarction. Therefore, TCD may be useful for predicting a poor functional outcome in patients with acute ischemic stroke.
참고문헌 (22)
- 진복희, "경두개 도플러 초음파의 측정지표와 성", 연령의 상관성, 2010, pp.42(3), 155~160[DOI]
- Kidwell CS, "Transcranial Doppler pulsatility indices as a measure of diffuse small-vessel disease", J Neuroimaging, 11, pp.229~235 (2001)[DOI]
- Rorick MB, "Transcranial Doppler correlation with angiography in detection of intracranial stenosis", Stroke, 25, pp.1931~1934 (1994)[DOI]
- Wijnhoud AD, "The prognostic value of pulsatility index, flow velocity, and their ratio, measured with TCD ultrasound, in patients with a recent TIA or ischemic stroke", Acta Neurol Scand, 124, pp.238~244 (2011)
- Wakerley BR, "Usefulness of transcranial Doppler-derived cerebral hemodynamic parameters in the noninvasive assessment of intracranial pressure", J Neuroimaging, 25, pp.111~116 (2015)[DOI]
- Altmann M, "Middle cerebral artery pulsatility index is associated with cognitive impairment in lacunar stroke", J Neuroimaging, 26, pp.431~435 (2016)[DOI]
- 김진권, "The Effect of Pulsatility Index on Infarct Volume in Acute Lacunar Stroke", Yonsei Medical Journal, 57(4), pp.950~955 (2016), 연세대학교의과대학[DOI]
- Micieli G, "Bilateral asymmetry of cerebral blood velocity in cluster headache", Cephalalgia, 14, pp.346~351 (1994)[DOI]
- Mayer SA, "Asymmetry of intracranial hemodynamics as an indicator of mass effect in acute intracerebral hemorrhage. A transcranial Doppler study", Stroke, 27, pp.1788~1792 (1996)[DOI]
- Brint SU, "MCA flow asymmetry is a marker for cerebrovascular disease", Neurol Res, 18, pp.163~167 (1996)[DOI]
- Zanette EM, "Comparison of cerebral angiography and transcranial Doppler sonography in acute stroke", Stroke, 20, pp.899~903 (1989)[DOI]
- Nam HS, "Long-term mortality in patients with stroke of undetermined etiology", Stroke, 43, pp.2948~2956 (2012)[DOI]
- Jones DW, "Seventh report of the Joint National Committee on Prevention, Detection, Evaluation, and Treatment of High Blood Pressure and evidence from new hypertension trials", Hypertension, 43, pp.1~3 (2004)[DOI]
- "Expert Committee on the Diagnosis and Classification of Diabetes Mellitus, Report of the expert committee on the diagnosis and classification of diabetes mellitus", Diabetes Care, 26(Suppl 1), pp.5~20 (2003)[DOI]
- Expert Panel on Detection, "Executive Summary of The Third Report of The National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, And Treatment of High Blood Cholesterol In Adults (Adult Treatment Panel III)", JAMA, 285, pp.2486~2497 (2001)[DOI]
- Wijnhoud AD, "Relationships of transcranial blood flow Doppler parameters with major vascular risk factors: TCD study in patients with a recent TIA or nondisabling ischemic stroke", J Clin Ultrasound, 34, pp.70~76 (2006)[DOI]
- Wunderlich MT, "Recanalization after intravenous thrombolysis: does a recanalization time window exist?", Neurology, 68, pp.1364~1368 (2007)[DOI]
- Restrepo L, "Transcranial Doppler markers of diffusion-perfusion mismatch", J Neuroimaging, 13, pp.34~42 (2003)[DOI]
- Kargiotis O, "Transcranial color-coded duplex in acute encephalitis: current status and future prospects", J Neuroimaging, 26, pp.377~382 (2016)[DOI]
- Kim J, "Brachial-ankle pulse wave velocity for predicting functional outcome in acute stroke", Stroke, 45, pp.2305~2310 (2014)[DOI]
- Baracchini C, "The quest for early predictors of stroke evolution: can TCD be a guiding light", Stroke, 31, pp.2942~2947 (2000)[DOI]
- McMahon CJ, "The reproducibility of transcranial Doppler middle cerebral artery velocity measurements: implications for clinical practice", Br J Neurosurg, 21, pp.21~27 (2007)[DOI]