TCD Examination, Risk Factors And Prognosis In Patients With Acute MCA Infarction

Background: Stroke is a syndrome of neurologic impairment which is caused by acute brain blood dysaemia,including ischemic strokes and hemorrhagic strokes. The annual incidence rate of stroke is about 61/100 thousand to 388/100 thousand all over the world.In China,the annual incidence rate of stroke is about 120/100 thousand to 180/100 thousand. Cerebral infarction, which has high mortality rate and mutilation rate, is the most common type of ischemic strokes, accounting for approximately 60% 80%. Depending on the population studied, intracranial atherosclerosis accounts for 1/3–1/2 of brain ischemic events.And the middle cerebral artery (MCA) stenosis accounts for 66%–73.3% of intracranial atherosclerosis. Studies about middle cerebral artery infarction were most on diagnosis and treatment, more than on the interconnection between imaging examination on acute stage and prognosis. Transcranial Doppler ultrasonography (TCD) is the only noninvasive examination method that enables the reliable evaluation of blood flow from the basal intracerebral vessels, adding physiologic information to the anatomic images. TCD is relatively inexpensive, can be performed at bedside, and allows monitoring in acute emergency settings and for prolonged periods with a high temporal resolution. So it could be very significant to detect the interconnection between TCD examination on acute stage of middle cerebral artery infarction and prognosis.Objective: To investigate the value of TCD examination on acute stage of middle cerebral artery infarction. To investigate the interconnection between TCD examination on acute stage and prognosis. To investigate the relationship between some risk factors of middle cerebral artery infarction and prognosis.Methods: 381 inpatients (age 21~81,[mean] 52.92±12.01, 276 men,105 women) in this study with acute MCA infarction were enrolled in the Neurology Department and Neurosurgery Department of the NO.1 Clinical Hospital of Jinlin University from 1-2007 to 12-2008, and were hospitalized and examined by TCD within 72 hours after stroke onset and proved with head CT or MRI. The type of TCD detector is TC-8080 TCD made in EME Company in Germany. The probe pulse frequency is 2MHz. There are four steps to studies:1.Among 381 patients, 63 of them both have TCD and MRA, and 126 middle cerebral arteries were detected. The number of abnormal arteries was 103 by MRA, and 99 by TCD. To investigate the concordance rate of TCD and MRA by comparative of the two results, and to investigate the sensitivity and specificity of TCD.2. All the patients were divided to two groups: the MCA normal group (179 patients) and the MCA abnormal group(202 patients). TO investigate the differences on various risk factors (gender, age, hypertension, diabetes, high blood cholesterol, increased fibrinogen levels, smoking history, alcohol history, family history of stroke) between the two groups.3. All the patients were divided to three groups: the MCA normal group (179 patients), the MCA stenosis group(124 patients), the MCA occlusive group (179 patients). All the patients were assessed by The National Institutes of Health Stroke Score (NIHSS) twice(on the 1st and the 14th days after the patients were hospitalized) ,then calculate the changes in the percentage of the initial NIHSS. TO investigate the differences on the changes in the percentage of the initial NIHSS among the three groups.4. All the patients were divided by the changes in the percentage of the initial NIHSS to three groups: basic recovery group(91%～100%, 20 patients),improved group(18%～90%,278 patients), invalid group(≤17%,83 patients). TO investigate the differences on various risk factors (gender, age, hypertension, diabetes, high blood cholesterol, smoking history, alcohol history, the initial NIHSS) among the three groups.Results:1.The results between TCD and MRA were insignificantly different (χ~2=1.125, P>0.05), and the concordance rate of TCD and MRA was 93.65%. The sensitivity and specificity of TCD were 94.17% and 91.30%. 2.There were 8 risk factors were confirmed as predictors of MCA stenosis or occlusion: gender (χ2=24.783, P<0.001, OR=3.277, 95% CI= 1.772～6.061), age (χ~2=13.481, P=0.002, OR=1.034, 95%CI=1.012～1.057), hypertension(χ~2=12.340, P=0.008, OR=2.008, 95%CI=1.204～3.350), diabetes (χ~2=16.537, P<0.001, OR=2.631, 95%CI=1.204～3.350), high blood cholesterol (χ~2=7.543, P=0.006), increased fibrinogen levels (χ~2=7.070, P<0.001, OR=3.405, 95% CI=2.082～5.568), smoking history (χ~2=9.331, P=0.009, OR=2.087, 95% CI=1.199～3.632), alcohol history (χ~2=7.578, P=0.006). And gender, age, hypertension, diabetes, increased fibrinogen levels and smoking history were had positive correlation with MCA stenosis or occlusion in Logistic regression analysis. 3. There were 6 risk factors were confirmed as predictors of the prognosis of MCA Infarction: gender (χ~2=14.537, P=0.001), age (t=2.612, P=0.009), diabetes (χ~2=12.465, P=0.002), and MCA stenosis or occlusion.Conclusions:1.In acute MCA infarction,TCD can be used at the first examination. The results between TCD and MRA were insignificantly different.It could be very helpful for better evaluate the situation changes of MCA if we combinate of both TCD and MRA.2There were 8 risk factors were confirmed as predictors of MCA stenosis or occlusion: gender, age, hypertension, diabetes, high blood cholesterol, increased fibrinogen levels, smoking history, alcohol history.And gender, age, hypertension, diabetes, increased fibrinogen levels and smoking history were significant risk factors.3. There were 5 risk factors were confirmed as predictors of the prognosis of MCA Infarction: gender, age, diabetes, initial NIHSS and MCA stenosis or occlusion. 4. In the acute phase of MCA infarction, TCD can be used to determine the extent of vascular disease and provide the information about the hemodynamic status of the cerebral circulation in order to speculate the prognosis for the treatment.