The Application Of TCD In The ASCO Subtypes Of Ischemic Stroke

Objective:Ischemic stroke is a clinical syndrome due to multiple causes, which includesdifferent etiology, mechanisms, the degree of brain damage, clinical characteristicsand prognostication. Therefore, a reliable and precise etiologic classification is highlyimportant in the decision-making, outcome and prevention of recurrence of ischemicstroke. TCD widely used in estimating severity and prognostic evaluation of acutecerebral infarction. Nevertheless, few studies have explored its association withstroke subtype, especially ASCO subtypes. This article highlights the relationshipwith TCD changes and MES monitoring research in ASCO subtypes.Methods:We analyzed data from89acute ischemic stroke patients who wereconsecutively admitted to the Second Affiliated Hospital of Nanchang Universitybetween March in2011and March in2012. For each, physical data, family history,previous medical history and fully diagnostic tests were recorded: age, gender, historyof diabetes mellitus, hypertension and atrial fibrillation, neurovascular imaging tests(duplex, MRI/MRA/ECG).After stroke work-up, we classified the patients usingASCO classification systems. All Patients presenting with acute ischemic strokewithin7days of stroke onset were subjected to TCD examinations through thetemporal and suboccipital windows using a2MHz probe and MES monitoring inbilateral MCA. Peak systolic, mean and end diastolic velocities as well as pulsatilityindex were noted. According to these cerebral hemodynamic results, TCD changeswere graded for with or without stenosis, degree of stenosis and PI change. Weanalyzed all the results with the SPSS17.0.Results：1. Distribution of evidence grade1with ASCO classification was as follows:A1（46.07%）>S1（37.08%）>C1（8.99%）>O1（3.37%）；2. Distribution of evidence grade1or2or3with ASCO classification was as follows: A（79.78%）>S（67.42%）>O（35.96%）>C（16.85%）；3. TCD of evidence grade1with ASCO classification: A1（90.24%） has higherodds and severer of stenosis than S1（30.30%）; however, S1（84.85%） has higherPI than A1（39.02%）；4. TCD of evidence grade1or2or3with ASCO classification: A（71.83%）hashigher odds and severer of stenosis than S（55%）; however, S（61.67%）has higherPI than A（22.54%）；5. TCD with different subtypes in the same classification: A1（90.24%） hashigher odds and severer of stenosis than A3（46.67%）; however, S1（46.67%） hashigher PI than S3（33.33%）；6. The positive rate of MES: The positive rate of MES in the small-vesseldisease（15%） is lower than atherosclerosis（28.17%）and cardiac disease（26.67%）；7. In the same classification, the positive rate of MES is different in differentsubtypes, A1（36.59%） is higher than A3（16.67%）, and S1（18.18%） is higherthan S3（11.11%）.Conclusion：1. Distribution of etiology with ASCO, evidence grade1or evidence grade1or2or3, atherosclerosis has the highest propotion.2. TCD changes are given priority to stenosis in atherosclerotic thrombosis,while normal TCD or PI increased as the main feature in small vessel disease.3. The positive rate of MES has correlation with infarction category, small-vesseldisease is lower than atherosclerosis and cardiac disease.4. The positive rate of MES is positively correlated with the severity of thevascular stenosis, the severer of stenosis, the higher positive rate of MES.