Key result
In acute ischemic stroke patients, ipsilateral carotid stenosis >90% or occlusion was independently associated with a significantly lower middle cerebral artery pulsatility index (difference -0.136).
Why the study?
High-grade carotid artery stenosis alters middle cerebral artery hemodynamics, but the influence of carotid stenosis and other clinical or radiological variables on middle cerebral artery pulsatility index required quantitative evaluation in acute ischemic stroke.
Does high-grade carotid artery stenosis and other clinical factors influence the pulsatility index in the middle cerebral artery of acute ischemic stroke patients?
Observational (n=1,821)
No
Does high-grade carotid artery stenosis and other clinical factors influence the pulsatility index in the middle cerebral artery of acute ischemic stroke patients?
Answers are grounded in this paper and cite their sources.
High-grade ipsilateral carotid stenosis significantly reduces the middle cerebral artery pulsatility index in acute ischemic stroke patients, while age, diabetes, and severe plaque burden increase it.
Cervical and transcranial Doppler (TCD) are widely used as non-invasive methods in the evaluation of acute ischemic stroke (AIS) patients. High-grade carotid artery stenosis induces haemodynamic changes such as collateral flow and a so-called post-stenotic flow pattern of the middle cerebral artery (MCA), which appears flattened, with a reduction of the velocity difference between systole and diastole. We studied the influence of carotid artery stenosis and other variables on the flow pattern in the MCA using the pulsatility index (PI), a quantitative TCD parameter reflecting the flow spectrum in a large of cohort AIS patients. We performed ultrasound examinations of 1825 AIS patients at the CHUV from October 2004 to December 2014. We extracted patient characteristics from the ASTRAL registry. Carotid stenosis severity was classified as < 50%, 50-70%, 70-90% and > 90%, or occlusion, according to Doppler velocity criteria. We first determined variables associated with stenosis grade. Then we performed a multivariate analysis after adjusting for baseline differences, using MCA PI as dependent variable. Carotid stenosis > 70% (- 0.07) and carotid stenosis > 90%, or occlusion (- 0.14) and left side (- 0.02) are associated with lower MCA PI values. Age (+0.006 PI units per decade), diabetes (+0.07), acute ischemic changes on initial CT (+0.03) and severe plaque morphology (+0.18) are associated with higher MCA PI values. We found a number of clinical and radiological conditions that significantly influence the PI of the MCA, including high-grade ipsilateral carotid stenosis in AIS patients. We provide for the first time a quantitative evaluation of the effect of these influencing factors from a large cohort of AIS patients.
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Bill et al. (2020) conducted an observational in Acute ischemic stroke (n=1,821). Carotid stenosis >90% or occlusion vs. No stenosis (<50%) was evaluated on Middle cerebral artery pulsatility index (MCA PI) (Difference -0.136, 95% CI -0.169 to -0.103, p=<0.01). In acute ischemic stroke patients, ipsilateral carotid stenosis >90% or occlusion was independently associated with a significantly lower middle cerebral artery pulsatility index (difference -0.136).
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