경두개 초음파를 이용한 두개내동맥 협착의 추적조사

Abstract

Background and Purpose : The natural history of intracranial arterial stenoses remains unknown. To investigate the natural course of the stenoses in the intracranial cerebral arteries and the possible role of clinical prognostic factors, we conducted a prospective study using transcranial Doppler (TCD)ultrasonography. Methods : We performed TCD study on 83 stroke patients with angiographically documented stenosis of middle cerebral artery (MCA) or basilar artery (BA). The findings were compared to repeat TCD studies conducted more than 2 months apart with respect to changes in mean flow velocities (mFV) of the stenotic segment. We analyzed the clinical data of all patients including risk factors of atherosclerosis, electrocardiogram, echocardiogram, and patterns of stenosis, which may affect the natural history of arterial stenosis. Results : Ninety seven arteries (47 left MCA, 31 right MCA, and 19 BA) from 83 patients (65 men and 18 women; mean age 56.6 years) were serially examined. During a mean follow-up period of 364 days, 23 (23.7%) arteries had TCD evidence of stenosis progression and 26 (26.8%) showed stenosis regression. BAs more often showed stenosis regression than did MCAs (p<0.05), and arteries with symptomatic stenosis more often regressed than those not causing neurological symptoms (p<0.05). Age, sex, or any risk factors of atherosclerosis were not associated with the course of the stenosis. Conclusion : These findings suggest that stenoses of intracranial arteries are dynamically changed, and that they may progress or regress within a relatively short period of time. Atherosclerotic risk factors are not related to the progression or regression of the stenoses whereas symptomatic (versus asymptomatic) stenosis and BA (versus MCA) involvement are factors related to regression of the stenosis. Korean Journal of Stroke 2000;2(1): 53~56