The Clinical Value Of Hemodynamic Changes In Ischemic Stroke Patients

BackgroundIschemic stoke has high morbidity, mortality and disability rate which badly threatens human health and life quality. And dysfunctions in movement, recognition load heavy burdens on the family and society as well. The main techniques of imaging diagnosis of ischemic stroke patients are computer tomography and Magnetic Resonance Imaging, which reflect changes of brain tissue. Cerebral angiography studies the condition of blood flow of cranial vessels. It mainly reflects changes of vessels appearance and it is invasive.Transcranial Doppler ultrasonography examination studies hemodynamics of basiccranial vessels and its branches with Doppler principle of ultrasound. It is simple, inexpensive, noninvasive, repeatable and can be performed at bedside. It is not only used to screen vessel stenosis of ischemic stroke patients, but also to understand pathogenesis, provide Diagnostic basis,estimate illness severity,evaluate Prognosis, direct therapy and evaluate therapeutic effect .ObjectTo evaluate the clinical value of the hemodynamic changes of Transcranial Doppler (TCD) in acute ischemic stroke patients.Methods109 patients with first attack of acute ischemic stroke were studied using TCD examination within 2 days of the onset of symptoms,computer tomography angiography and arterial digital angiography were performed within 5 days after TCD examination.1. 54 patients with cerebral infraction were detected by CTA/DSA to study the cause of elevated blood flow velocity in TCD.2. A subgroup of patients with symmetry of the blood velocity of MCA with high blood velocity , a subgroup of patients with asymmetry of the blood velocity of MCA with normal blood velocity and a subgroup of asymmetrical high blood velocity were respectively compared with each other to valuate the ratio of stenosis.3. Cerebral infraction area was calculated with Computer Tomography or Magnetic Resonance Imaging and values the correlation between cranial artery with high blood flow velocity and responsible vessels.4. Study the collection between ratio of bilateral PI difference of ICA and ratio of occlusion on the higher side.5. The blood flow velocities on the affected side and on the unaffected side were compared in the 34 patients with unilateral symptomatic MCA stroke (22 cerebral infraction and 12 TIA) and without stenosis in intra- and extra-cranial artery. Results1. At high blood flow velocity cases, artery stenosis and compensatory elevated were the most common causes.2. Ratio of artery stenosis of asymmetry high blood velocity group is 61.29% and has significant difference with normal blood velocity(31.25%,P< 0.05), has no significant difference with symmetry high blood velocity (61.54%, P> 0.05). Ratio of artery stenosis of the higher side of asymmetry high blood velocity group is 48.39% and has significantly difference with normal blood velocity(0,P< 0.05), has no significant difference with ratio of symmetry high blood velocity (38.46%, P> 0.05). Ratios of stenosis artery were significant difference between symmetry high blood velocity and normal blood velocity (0,P< 0.05).3. A highly positive predictive value of elevated blood flow velocity in favor of related-focus (83.33%) and the responsible vessels of the infraction (70.37%) were found.4. Positive collection was found between ratio of bilateral PI difference and ration of occlusion on the higher side(OR=0.977,P< 0.05).5. Unilateral blood flow velocities were significantly lower on the affected side than they were on the unaffected side (P< 0.05) in the patients with cerebral infraction and without stenosis in intra- and extra-cranial artery. But there is no significant difference in the patients with TIA(P>0.05).Conclusions 1. Both asymmetry high blood velocity and symmetry high blood velocity have value in diagnosis of vessel stenosis.2. Our data showed that TCD yields a satisfactory agreement with elevated blood flow velocity in predicting the related-focus and the responsible vessels of cerebral strokes.3. the ratio of bilateral PI difference of ICA may be a risk factor of collusion in cerebral infraction patients.4. Unilateral blood flow velocities were significantly lower on the affected side than they were on the unaffected side in the patients with ischemic attack and without intra-and extra-cranial artery stenosis appears to be associated with diagnosis and clinical outcome of these patients.