Study on relationship among pulsatility index, sustained attention function and collateral circulation in patients with severe stenosis or occlusion of internal carotid artery / 临床神经病学杂志

ABSTRACT

Objective To investigate the relationship among pulsatility index ( PI) , sustained attention function and collateral circulation in patients with severe stenosis or occlusion of internal carotid artery .Methods One hundred and thirty-five patients with severe stenosis or occlusion of internal carotid artery were examined by DSA and were divided into different groups according to the type of collateral circulation .Meanwhile, 30 healthy aged people were selected as a control group .The peak systolic velocity ( Vs) , and diastolic velocity ( Vd) , mean velocity ( Vm) and PI of bilateral middle cerebral artery were obtained by TCD .Sustained attention was evaluated by missed and mistaken scores as well as average reaction time of continuous performance test .The results were compared and analyzed.Results (1)According to the type of collateral circulation , 135 patients with severe stenosis or occlusion of internal carotid artery were divided into groups with patency of anterior communicating artery (AcoA)(31 cases),posterior communicating artery (PcoA)(20 cases), AcoA+PcoA (19 cases), primary collateral circulation (with AcoA, PcoA and AcoA +PcoA) (70 cases), secondary collateral circulation (including ophthalmic artery, leptomeningeal collateral vessel and new blood vessels ) ( 15 cases ) , primary+secondary collateral circulation ( 13 cases) and group without collateral circulation (37 cases).(2)Compared with control group, Vs,Vd,Vm and PI all decreased significantly in every other group ( all P<0.05 ) .Compared with group without collateral circulation , Vd of group with AcoA or primary collateral circulation , Vd and Vm of group with AcoA +PcoA all increased significantly;PI of groups with AcoA , AcoA+PcoA, primary collateral circulation and primary +secondary collateral circulation all decreased (all P<0.05).Compared with group with PcoA, PI of groups with AcoA and AcoA +PcoA both decresed significantly (all P<0.05).Compared with group with secondary collateral circulation , Vs,Vd and Vm of group with primary collateral circulation , Vd and Vm of group with primary +secondary collateral circulation all increased significantly; PI of groups with primary collateral circulation and primary +secondary collateral circulation both decreased (all P<0.05).(3) Compared with control group, the missed, mistaken scores and average reaction time of CPT in every other group increased significantly ( all P<0.05 ) .Compared with group without collateral circulation , the missed, mistaken scores and average reaction time in groups with AcoA , AcoA+PcoA and primary collateral circulation all decreased significantly; the missed and mistaken scores of group with primary+secondary collateral circulation decreased significanly ( all P<0.05) .Compared with group with PcoA , the missed and mistaken scores of group with AcoA decreased significantly while the missed , mistaken scores and average reaction time of group with AcoA +PcoA all decreased significantly ( all P<0.05 ) .Compared with group with AcoA+PcoA, the missed, mistaken scores and average reaction time in group with AcoA increased sinificantly ( all P<0.05).Compared with group with secondary collateral circulation , the missed, mistaken scores and average reaction time in group with primary collateral circulation all decreased significantly ;the missed and mistaken scores in primary+secondary collateral circulation both decreased significantly ( all P<0.05 ) .( 4 ) PI positively related to average reaction time in groups with AcoA , primary and secondary collateral circulation ( r=0.441, r=0.364, r=0.552; all P<0.05 ) .PI positively related to missed scores in group with PcoA and group without collateral circulation (r=0.668, r=0.397;all P<0.05).PI also positively related to mistaken scores in the above groups (r=0.509,r=0.480;all P<0.05).Conclusion High PI on the affected side of patients with severe stenosis or occlusion of internal carotid artery may reflect impairment of sustained attention function .