The Research Of Evaluating Leptomeningeal Anastomoses In Patients With Unilateral Middle Cerebral Artery Severe Stenosis Or Occlusion By Ultrasound

ObjectiveIn this study,by the examination of transcranial doppler(TCD)/ transcranial color code sonography(TCCS)detected the change in the mean velocity of bilateral anterior cerebral artery(ACA)and posterior cerebral artery(PCA)to response leptomeningeal anastomoses(LMA)status.MethodsFrom september 2018 to october 2019,the study collected 161 patients in our hospital diagnosed as unilateral MCA severe stenosis or occlusion by TCD /TCCS and confirmed by digital subtraction angiography(DSA).According to the ASITN/SIR grade system,the patients were divided into three group :non-LMA(SIR= 0)(n=53),the group with poor LMA(SIR= 1-2)(n=53)and the group with good LMA(SIR= 3-4)(n=55).General information and biochemical indicators were collected.Mean velocity(MV)of ACA and PCA on both sides was recorded and detected by TCD/TCCS,and the MV of ACA and PCA on the affected side /the healthy side was calculated.Results1.The NIHSS score in the non-LMA group was higher than other groups,the difference was statistically significant(P < 0.05),there was mild negative correlation between NIHSS score and the LMA status(r =-0.179,P < 0.05).2.There is no statistically difference in the mean velocity of ACA,PCA between the affected side and the healthy side in the non-LMA group(P > 0.05).Between the poor LMA group and the good LMA group,the difference was statistically significant in the mean velocity of ACA,PCA in the affected side andthe healthy side(P(27)0.001).3.Between the non-LMA and the poor LMA group,there was a statistically difference in the mean velocity of ACA,PCA in the affected side(P < 0.01).The difference between the non-LMA and the good LMA group was statistically significant(P < 0.01).The difference in the mean velocity of ACA in the affected side between the group with poor LMA group and the good LMA group was statistically significant(P(27)0.01).But there was no statistically significant difference in the mean velocity of PCA in the affected side between the poor LMA and the good LMA group(P > 0.05).There was no statistically difference in the mean velocity of ACA,PCA in the healthy side between the three groups(P > 0.05).Between the mean velocity of ACA,PCA in the affected side and the LMA status had a positive correlation(r=0.489,P < 0.001;r=0.331,P < 0.001).There was no statistical significance between in the LMA status and the mean velocity of ACA,PCA in the healthy side(P > 0.05).4.Between the non-LMA and the other groups(poor LMA group and good LMA group),there was a significant difference in the the mean velocity of ACA,PCA on the affected side / the healthy side(P < 0.001).Between the poor LMA and good LMA group,there was a statistically difference in the the mean velocity of ACA on the affected side / the healthy side(P < 0.05).The difference in the the mean velocity of PCA on the affected side / the healthy side between the poor LMA group and good LMA group was no statistically significant(P > 0.05).In our study,there was a moderate positive correlation between the mean velocity of ACA,PCA on the affected side / the healthy side and the LMA status(r= 0.592,P < 0.001;r = 0.426,P< 0.001).5.ROC curve analysis of the mean velocity of ACA,the mean velocity of PCA,the MV of ACA,PCA on the affected side / the healthy side was statistically significant(P < 0.001).There was no statistical significance in the the mean velocity of ACA,PCA on the healthy side(P > 0.05).The maximum area under the ROC curve of the mean velocity of ACA,PCA,the mean velocity of ACA and PCA on theaffected side / the healthy side respectively was 0.826,0.726,0.874,0.780.The optimal critical value was 140cm/s,89cm/s,1.33,1.31.The Yorden indexes was0.69,0.466,0.636,0.502.The Sensitivity and specific degree respectively was70.9%?98.1%,63.6%?83.0%,78.2%?92.5%,69.1%?81.1%.Conclusion:1.The result of this study showed that the higher LMA grade represented the patient's condition was not serious,on the contrary,the patient's condition were worse.2.For the patients of unilateral MCA severe stenosis or occlusion,TCD can determined the status of LMA by detecting the mean velocity and the ratio on the affected side / the healthy side.The patients had higher the mean velocity or ratio,the LMA grades were better.3.Among all the mean velocity and ratio,the mean velocity of ACA and the mean velocity of ACA on the affected side / the healthy side have the better diagnosis for good LMA.When the mean velocity of ACA ? 140m/s and the mean velocity ratio of ACA ? 1.33,the LMA status was good.