The effect of leptomeningealanastomoseson hemodynamic changes of extracranial internal carotid artery in middle cerebral artery severe stenosis and occlusion disease

doi:10.3877/cma.j.issn.1672-6448.2017.06.008

Abstract

Abstract:

Objective

To investigate the influence of anterior cerebral artery (ACA) leptomeningealanastomoseson the hemodynamic changes of extracranial internal carotid artery (ICA) in patients with severe stenosis and chronic occlusion of middle cerebral artery (MCA) disease.

Methods

One hundred and eighty six cases with severe stenosis and chronic occlusion of MCA diagnosed by transcranial color-coded sonography (TCCS) and confirmed by digital subtraction angiography (DSA) were consecutively enrolled during January 2015 to December 2015. All cases were divided into two groups, including 88 cases of severe stenosis and 98 cases with chronic occlusion. According to DSA results, there were 72 cases with leptomeningeal anastomoses (LMA) and 114 cases without LMA. Transcranial Doppler (TCD) and TCCS were performed to measure and record the peak systolic velocity (PSV), end diastolic velocity (EDV), and resistance index (RI) of bilateral ACA, color Doppler ultrasound was used to measure and record PSV, EDV and RI of bilateral ICA. The ipsilateral and contralateralhemodynamic parameters of ICA and ACA were compared betweenthe two groups by means of independent-samples t test and paired-samples t test. The difference ofhemodynamic parameters between patients with LMA and without LMA were also compared. Linear regression was used to analyze the relevance between ipsilateral ICA and ACA parameters.

Results

(1) The PSV and EDV of ipsilateral ICA in MCA chronic occlusion group were significantly lower than those in MCA severe stenosis group [(71.27±17.84) cm/s vs (78.07±14.69) cm/s, (27.00±8.38) cm/s vs (32.01±7.83) cm/s, 0.625±0.056 vs 0.591±0.057; t=2.820, 4.243, 4.099, all P<0.01]. The PSV and EDV of ipsilateral ICA were significantly lower than the contralateral side in both two group [PSV: (78.07±14.69) cm/s vs (85.26±17.42) cm/s, (71.27±17.84) cm/s vs (83.80±22.11) cm/s; EDV: (32.01±7.83) cm/s vs (34.50±7.36) cm/s, (27.00±8.38) cm/s vs (33.22±9.97) cm/s; t=2.847, 5.209, 2.058, 5.626, all P<0.05]. The RI of ipsilateral ICA was higher than that of contralateral side in MCA chronic occlusion group (0.625±0.056 vs 0.601±0.076, t=2.601, P<0.05), no significantly differenceexist between the RI of two sides were in MCA severe stenosis group (P>0.05). (2) In two groups, the PSV and EDV of ipsilateral ICA with LMA were significantly higher than those without LMA, while the RI was lower [PSV: (164.19±22.64) cm/s vs (97.56±19.17) cm/s, (168.95±28.03) cm/s vs (96.72±21.57) cm/s; EDV: (75.68±12.53) cm/s vs (42.65±10.03) cm/s, (79.93±13.73) cm/s vs (42.30±11.95) cm/s; RI: 0.540±0.036 vs 0.564±0.043, 0.526±0.037 vs 0.566±0.051; t=14.604, 14.416, 13.492, 14.444, 2.727, 4.250, all P<0.01]. The PSV and EDV of ipsilateral ACA with LMA were higher than the contralateral side, and RI was lower [PSV: (164.19±22.64) cm/s vs (105.19±26.95) cm/s, (168.95±28.03) cm/s vs (97.90±24.18) cm/s; EDV: (75.68±12.53) cm/s vs (44.10±13.87) cm/s, (79.93±13.73) cm/s vs (41.83±10.88) cm/s; RI: 0.540±0.036 vs 0.583±0.050, 0.526±0.037 vs 0.572±0.037; t=10.049, 15.906, 10.313, 16.864, 4.083, 6.145, all P<0.01]. For the parameters of ACA without LMA, there was no difference between two sides (P>0.05). (3) In MCA with severestenosis group, the parameters of ipsilateral ICA between with and without LMA groupswere not significantly different (P>0.05). In MCA with chronicocclusion group, the PSV and EDV of ipsilateral ICA without LMA were significantly lower than those with LMA, and RI was higher [(65.93±13.34) cm/s vs (78.68±20.64) cm/s, (23.98±6.30) cm/s vs (31.20±9.08) cm/s, 0.638±0.055 vs 0.605±0.053; t=3.713, 4.647, 2.925, all P<0.01]. (4) In MCA with severestenosis group, no obviously correlation was found in the hemodynamic parameters of ipsilateral ICA and ACA (P>0.05). In MCA with chronicocclusion group, PSV, EDV of ipsilateral ACA had positive linear correlation with PSV of ipsilateral ICA (r=0.350, 0.367, P<0.01), and had negative linear correlation with RI of ipsilateral ICA (r=-0.550, -0.531, P<0.01).

Conclusions

In MCA with severestenosis and chronicocclusinpatients, TCD or TCCS can be used for detecting increased velocity of ACA with LMA. The hemodynamic parameters of ipsilateral ICA could beinfluenced by LMA withdecreased velocity and increased PI when MCA was occluded, but could not be influenced by LMA when MCA was severe stenosis.

Key words: Middle cerebral artery, Ultrasonography, Doppler, color, Carotid artery, internal, Hemodynamic

Xiang Li, Jie Yang, Lingyun Jia, Xinyu Zhao, yang Hua. The effect of leptomeningealanastomoseson hemodynamic changes of extracranial internal carotid artery in middle cerebral artery severe stenosis and occlusion disease[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2017, 14(06): 433-440.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2017.06.008

https://chaosheng.cma-cmc.com.cn/EN/Y2017/V14/I06/433

Figures/Tables 9

References 22

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组别	例数	年龄（岁，±s）	性别（例，男性/女性）	病变侧别[例（%）]		糖尿病[例（%）]	高血压[例（%）]
组别	例数	年龄（岁，±s）	性别（例，男性/女性）	左侧	右侧	糖尿病[例（%）]	高血压[例（%）]
MCA重度狭窄组	88	56±13	74/14	40（45.5%）	48（54.5%）	22（25.0%）	51（58.0%）
MCA慢性闭塞组	98	57±12	81/17	51（52.0%）	47（48.0%）	17（17.3%）	60（61.2%）
统计值	?	t=0.825	χ²=0.069	χ²=0.805		χ²=1.639	χ²=0.206
P值	?	0.411	0.793	0.370		0.200	0.650
组别	例数	冠状动脉粥样硬化性心脏病[例（%）]	高血脂[例（%）]	吸烟[例（%）]	临床症状[例（%）]
组别	例数	冠状动脉粥样硬化性心脏病[例（%）]	高血脂[例（%）]	吸烟[例（%）]	无症状	TIA	脑卒中
MAC重度狭窄组	88	8（9.1%）	38（43.2%）	58（65.9%）	4（4.5%）	10（11.4%）	74（84.1%）
MAC慢性闭塞组	98	12（12.2%）	40（40.8%）	67（68.3%）	7（7.1%）	13（13.3%）	78（79.6%）
统计值	?	χ²=0.515	χ²=0.107	χ²=0.127	χ²=0.779
P值	?	0.473	0.744	0.721	0.677

组别	例数	年龄（岁，±s）	性别（例，男性/女性）	病变侧别[例（%）]		糖尿病[例（%）]	高血压[例（%）]
组别	例数	年龄（岁，±s）	性别（例，男性/女性）	左侧	右侧	糖尿病[例（%）]	高血压[例（%）]
MCA重度狭窄组	88	56±13	74/14	40（45.5%）	48（54.5%）	22（25.0%）	51（58.0%）
MCA慢性闭塞组	98	57±12	81/17	51（52.0%）	47（48.0%）	17（17.3%）	60（61.2%）
统计值	?	t=0.825	χ²=0.069	χ²=0.805		χ²=1.639	χ²=0.206
P值	?	0.411	0.793	0.370		0.200	0.650
组别	例数	冠状动脉粥样硬化性心脏病[例（%）]	高血脂[例（%）]	吸烟[例（%）]	临床症状[例（%）]
组别	例数	冠状动脉粥样硬化性心脏病[例（%）]	高血脂[例（%）]	吸烟[例（%）]	无症状	TIA	脑卒中
MAC重度狭窄组	88	8（9.1%）	38（43.2%）	58（65.9%）	4（4.5%）	10（11.4%）	74（84.1%）
MAC慢性闭塞组	98	12（12.2%）	40（40.8%）	67（68.3%）	7（7.1%）	13（13.3%）	78（79.6%）
统计值	?	χ²=0.515	χ²=0.107	χ²=0.127	χ²=0.779
P值	?	0.473	0.744	0.721	0.677

组别	例数	PSV（cm/s）		EDV（cm/s）		RI
组别	例数	患侧	健侧	患侧	健侧	患侧	健侧
MAC重度狭窄组	88	78.07±14.69^a	85.26±17.42	32.01±7.83^b	34.50±7.36	0.591±0.057	0.594±0.047
MAC慢性闭塞组	98	71.27±17.84^a	83.80±22.11	27.00±8.38^a	33.22±9.97	0.625±0.056^b	0.601±0.076
t值	?	2.820	0.498	4.243	0.983	4.099	0.820
P值	?	0.005	0.619	<0.001	0.327	<0.001	0.413

组别	例数	PSV（cm/s）		EDV（cm/s）		RI
组别	例数	患侧	健侧	患侧	健侧	患侧	健侧
MAC重度狭窄组	88	78.07±14.69^a	85.26±17.42	32.01±7.83^b	34.50±7.36	0.591±0.057	0.594±0.047
MAC慢性闭塞组	98	71.27±17.84^a	83.80±22.11	27.00±8.38^a	33.22±9.97	0.625±0.056^b	0.601±0.076
t值	?	2.820	0.498	4.243	0.983	4.099	0.820
P值	?	0.005	0.619	<0.001	0.327	<0.001	0.413

组别	例数	PSV（cm/s）		EDV（cm/s）		RI
组别	例数	患侧	健侧	患侧	健侧	患侧	健侧
软脑膜动脉吻合	31	164.19±22.64^a	105.19±26.95	75.68±12.53^a	44.10±13.87	0.540±0.036^a	0.583±0.050
无软脑膜动脉吻合	57	97.56±19.17	95.04±27.30	42.65±10.03	41.72±15.68	0.564±0.043	0.570±0.070
t值	?	14.604	1.675	13.492	0.707	2.727	0.930
P值	?	<0.001	0.098	<0.001	0.482	0.008	0.355

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