Application of transcranial doppler ultrasound in hemodynamic follow-up after thrombectomy of acute anterior circulation arterial occlusion / 中国脑血管病杂志

ABSTRACT

Objective To investigate the application of transcranial Doppler ultrasonography (TCD) in middle cerebral artery (MCA) hemodynamic follow-up after thrombectomy of acute anterior circulation arterial occlusion. Methods From December 2013 to May 2018,45 consecutive patients with acute anterior circulation arterial occlusion treated with Solitaire stent thrombectomy at the Department of Neurology, the Third People's Hospital of Hubei Province were enrolled retrospectively. There werel7 females and 28 males. According to PSV on the 1st day after operation ,45 patients were divided into high-flow rate (> 140cm/s) group and normal-flow rate (140 cm/s) group. The baseline and clinical data of both groups were collected and their differences were compared. The baseline data included age, gender, general risk factors for cardio-cerebrovascular diseases (hypertension,hyperlipidemia,diabetes,history of atrial fibrillation, and history of smoking and drinking). The clinical data included the National Institutes of Health Stroke Scale (NIHSS) score on admission,times of intraoperative thrombectomy,time from admission to recanalization, preoperative intravenous thrombolysis rate,modified Rankin scale (MRS) score. TCD was used to monitor and record the peak systolic velocity (PSV) and the end diastolic velocity (EDV) of the MCA at the 1st day,7th day,and 3rd month after operation. The correlation between high velocity of PSV on the 1st day after operation and intracranial hemorrhage and good prognosis was evaluated Results (1) Hyperlipidemia occurred in 5 of 13 patients in the high-flow rate group .and the incidence of hyperlipidemia in the normal-flow rate group was 6. 2% (2/32). Atrial fibrillation occurred in 2 of 13 patients in the high-flow rate group,and the incidence of atrial fibrillation in the normal flow rate group was 53.1% (17/32). There were statistically differences between the two groups (all P 0.05). (2) The residual stenosis rate after thrombectomy in the high-flow rate group was higher than that in the normal-flow rate group. There was significant difference between the two groups (30.0% [12. 5% ,45. 0%] vs. 0 [0,10. 0%] ,P 0.05). (3) The PSV of the high-flow rate group on the 1st day,the 7th day,and 3rd month after operation were 222 ±50,168 ±27, and 138 ± 24 cm/s, respectively, and those of the normal-flow rate group were 96 ±21,95 ±22,and 98 ± 17 cm/s,respectively. The interaction between groups and time points had statistical significance (F = 40. 659,P 0.05). (4) The EDV of the high-flow rate group on the 1st day,7th day and 3rd month after operation were 118 ±40,83 ± 15,and 67 ± 14cm/s,and those of the nonnal-flow rate group were 45 ± 10,44 ± 10,and 46 ± 8 cm/s,respectively. Hie interaction between groups and time points had statistical significance (F = 34. 699 ,P 0. 05). Conclusions TCD can be used for hemodynamic monitoring after thrombectomy of acute anterior circulation artery occlusion. There was elevated blood flow velocity in MCA after thrombectomy for the occlusion caused by atherosclerotic stenosis, and lead to intracerebral hemorrhage, however, a study with large sample is needed to cofirm it.