Assessment of Collateral Circulation through Anterior Cerebral Artery Using the Transcranial Doppler in Patients with Acute Middle Cerebral Artery Infarction

J Korean Neurol Assoc > Volume 23(2); 2005 > Article

Journal of the Korean Neurological Association 2005;23(2): 165-171.

중대뇌동맥 협착에 의한 급성 뇌경색 환자에서 경두개 초음파를 이용한 전대뇌동맥을 통한 측부혈액순환의 평가

남태승, 김태학 최성민* 이승한 박만석 김병채 김명규 조기현

전남대학교 의과대학 신경과학교실, 광주기독병원 신경과*

Assessment of Collateral Circulation through Anterior Cerebral Artery Using the Transcranial Doppler in Patients with Acute Middle Cerebral Artery Infarction

Tai-Seung Nam

Department of Neurology, Chonnam National University Medical School, Gwangju; Departement of Neurology, Gwangju Christian Hospital*, Gwangju, Korea

Abstract

Background: To investigate the optimal values of transcranial doppler (TCD) index in the evaluation of leptomeningeal collateral circulation (CC) in patients with middle cerebral artery (MCA) stenosis.
Methods: Forty-one patients, with angiographically confirmed single stenosis or occlusion of the M1 segment of the MCA, were studied with TCD and brain MRI. Patients were divided into two groups according to the existence of CC though ipsilateral anterior cerebral artery on transfemoral cerebral angiography (TFCA). Mean flow velocities (mFV) of anterior and middle cerebral arteries (ACA, MCA) were analyzed. We then investigated the optimal values of TCD flow index: 1) ipsilateral mFV ACA/MCA (AMVR), 2) ACA velocity ratio (ACAVR), 3) mFVACA. We then correlated TCD flow index with TFCA results.
Results: TFCA revealed single moderate to severe M1 stenosis (n=35) and occlusion (n=6). Presence of CC was found in 11 (27%), absence of CC in 30 (73%). The mean of AMVR, ACAVR and mFVACA differed between the two groups: 1.76±0.69, 1.43±36, 86.27±31.73 츠/s in the presence of CC; 0.48±0.24, 1.21±0.39, 65.93±23.24 in the absence of CC. The optimal cutoff values for detection of CC were found at AMVR≥0.9, ACAVR≥1.30 and mFVACA≥80 cm/s. The combination of individual TCD indexes had improved the specificity and positive predicted value in the detection of CC.
Conclusions: TCD enables detecting the existence of CC in patients with MCA stenoocclusion. These optimal values may provide a noninvasive method for evaluate the pathomechanism of stroke and prospect the prognosis of these patients. KeyWords:Middle cerebral artery stenosis, Transcranial doppler, Collateral circulation