Evaluation Of TCD And CDFI In Intra-and Extra-cranial Cerebral Artery Stenosis Or Occlusion

Arteriosclerosis is the important risky factor of ischemic stroke .As we allknow that ischemic stroke patients always accompany with intra-and extra-cranial cerebral artery stenosis or occlusion, that is mean that cerebral arteryocclusive disease is the fondation and risky factor of cerebral vascular disease.Cerebral artery occlusive disease of ischemic stoke patients attracts more andmore people giving much more attention in recent years, especially with thedevelopment and research in the interventional treament of intra-and extra-cranial cerebral artery stenosis. How to discover and evaluate the position anddegree of stenosis earlier,conveniently,no injurely and accurately,than providingthe reliable evidence for therapy and prognosis,is becoming the common target ofclinial doctors.Though DSA is regarded as the diagnostic gold standard for cerebral arterystenosis,it can not be the first and foremost method for cerebral arterystenosis,because it is injured and risky,it is also limited in some aspects.With theimprovement of sonography facilities and picture quality,it is very popular touse color doppler sonography in cerebral artery senosis diagnosis , but what weconcern is Doppler sonography's reliability because display and judgement of itsimage is excessively dependent on examiner's skill and experimence.The purposeof this study is to evaluate sonography's value in intra-and extra-cranial cerebralartey stenosis or occlusion ,and some of them compare with DSA or MRA. The data was from the fist hospital of jilin university from Mar.2004 toMar.2006.We selected 771 patients who suffered from intra-and extra-cranialcerebral artey stenosis or occlusion verified by both TCD and CDFI .It includedcarotid artery system disease 524 patients,vertebrobasilar system disease 153patients and subclavian artery system disease 94 patients. American GE companyLOGIC BOOK color Doppler flow imaging (CDFI) with the probe frequency of5 to 12Hz and 2 to 4 Hz was used to acquired the Doppler imaging .We observedhibateral Common carotid artery (CCA),extracranial part of Internal carotid artery(ICAex),extracranial part of Vertebral artery (VAE ) and Subclavian artery(SUBA).German EME company TC-8080 transcranial Doppler ultrosonography(TCD) with the probe frequency of 2Mhz and 4MHz was used to acquireDoppler imaging,We measured the velocity and PI index of hibateral Middlecerebral artery (MCA),Anterior cerebral artery (ACA),Posterior cerebal artery(PCA),Terminal internal carotid artery (TICA),intracranial part of Vertebral artery(VAI),Basilar artery(BA),Ophthalmic artery(OA),Siphon carotid artery(SCA) andSupratrochlear artery (StrA).All data is compiled by Access2000 database,theresults was analysed by SPSS 12.0 software package. The results as following:1. The results of carotid artery system:75 patients with carotid artery sever stenosis or occlusion ,used pairedsample T test to compare the velocity and PI of MCA in each side of hemisphere.P<0.001 in each group. The difference had notable significance. Unilateral carotidartery sever stenosis or occlusion had notably decreased the velocity and PI ofMCA. Used team sample T test to compare the velocity and PI of MCA accordingto anterior collateral pathway open or not, p<0.05 in each group.but it did notoccur in posterior and ECA-ICA collateral pathway team patients. 12 patientsof ICAex occlusive disease underwent DSA,the results was 9 ICAex stenosisdisease and 3 ICAex occlusion disease.However,the same patients enderwentCDFI,the results was 7 ICAex stenosis disease and 5 ICAex occlusiondisease.That was mean 2 patients with severe stenosis almost reach toocclusion ,but CDFI diagnosed them as absolute occlusion.To the stenosis ofMCAM1,TCD had a sensitivity of 90.9%,had a specificity of 96.2%.2.The results of vertebrobasilar artery system :137 patients of vertebrobasilar stenosis or occlusion were diagnosed by TCDand CDFI, 38 patients underwent DSA. Compared with DSA, the sensitivity andspecificity of TCD in detecting basilar stenosis or occlusion disease wasrespectively 75%, 93%.Compared with DSA,the sensitivity and specificity ofTCD and CDFI in detecting vertebral artery stenosis or occlusion disease wasrespectively 83%,91%. According to the results of DSA,the detecting rate of TCDin different segment of basilar stenosis or occlusion disease was respectively100%,80%,33%. According to the results of DSA,the detecting rate of TCD andCDFI in vertebrobasilar artery stenosis and occlusion disease was 79%,howeverMRA alone was 96%, united three methods the detecting rate was 98%.3.The results of subclavian artery system:Among the 94 SSS patients, 11 patients underwent DSA.According to thestenosis diagnosotic standars of DSA, 3 patients of steal stageⅡ and 1 patient ofsteal stageⅠin 75 %～95 %,2 patients of steal stageⅡ and 1 patient of steal stageⅠin 50%～74 %,4 patients of steal stage Ⅲ almost reaching occlusion orocclusion.In 11 patients, 4 patients of steal stageⅢ with TCD and CDFI showedthat blood flowed from oppsite side VA reverse to Ip-VA until then toIp-subclavain with DSA, and other 7patients of steal stageⅠ orⅡ showed thebiood flowed of Ip-VA slightly indifferent or partial reversed process with DSA.The conclusion as following:1.CDFI is regarded as a accurate method forICAex stenosis or occlusion ,but it has some difficulty in discriminate severestenosis and occlusion sometimes.. 2.TCD has high accuracy towards to MCAM1.3.Compared with DSA,the sensitivity of TCD and CDFI in vertebrobasilarstenosis or occlusion disease is relatively lower,but the specificity is still higher.4.Combine TCD,CDFI with MRA almost can replace DSA in diagnosis ofvertebrobasilar stenosis or occlusion disease. 5.TCD combine with CDFI is asensitive and reliable method for evaluating the steal phenomena in patients withsubclavian artery stenosis.6.TCD and CDFI is no-injured,cheap,accurate andcovenient,so it can be the first and foremost method in follow-up of interventionaltherapy.Above all,by analyzing the intra-and extra-cranial cerebral artery stenosis orocclusion disease, we evaluated the superiority and disadvantage of TCD andCDFI objectively in different arteries.Then clinical doctors can understand the twomethods more accurately and accept some advice and reference on selectingideal methods in clinical work.