Cerebral blood flow abnormalities in neurologically asymptomatic patients with primary antiphospholipid syndrome

Medina, Gabriela; Molina-Carrión, LE; Ángeles-Garay, Ulises; Vera‐Lastra, Olga; Arias-Flores, Rafael; Romero-Sánchez, Griselda; Jara, LJ

doi:10.1177/0961203312436853

Cited by 2 publications

(6 citation statements)

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“…8 The PI is an important haemodynamic parameter that linearly correlates with cerebral microvascular tone, blood flow resistance and impedance. 8 Other studies have evaluated PI in patients with SLE 40,49 and APS 6 and found no differences when compared with healthy volunteers. 6 In our series, patients with APS (either PAPS or SAPS) had a trend to present more intracranial stenosis than healthy volunteers.…”

Section: Discussionmentioning

confidence: 98%

“…8 Other studies have evaluated PI in patients with SLE 40,49 and APS 6 and found no differences when compared with healthy volunteers. 6 In our series, patients with APS (either PAPS or SAPS) had a trend to present more intracranial stenosis than healthy volunteers. Intracranial stenosis in patients with APS could be due to an aPLinduced vasculopathy or even intracranial atherosclerosis.…”

Section: Discussionmentioning

confidence: 98%

“…One previous study with neurologically asymptomatic patients with PAPS found significantly increased MFVs when compared with healthy controls. 6 The authors hypothesized that higher MFV could be a consequence of accelerated atherosclerosis, PAPS vasculopathy or both. 6 High MFVs were also found in two other studies in patients with SLE, suggesting the presence of a diffuse cerebral vasculopathy.…”

Section: Discussionmentioning

confidence: 99%

“…5 Therefore, abnormalities in cerebral blood flow could be a reflection of endothelial lesions. 6 In situ thrombosis and cardiac embolism are other possible mechanisms of stroke in patients with APS. 7 Transcranial Doppler (TCD) is a method that enables the assessment of different cerebral hemodynamic parameters such as the mean blood flow velocity (MFV) of intracranial arteries, pulsatility index (PI), vasomotor reactivity (VMR) and allows the detection of microembolic signal (MES) and right-to-left circulation shunt (RLS).…”

Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Transcranial Doppler findings in antiphospholipid syndrome

Ricarte

Dutra

Barsottini

et al. 2019

Lupus

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Introduction Transcranial Doppler is a method that enables the assessment of different cerebral hemodynamic parameters. It also allows for the evaluation of the presence of right-to-left circulation shunts (RLS) and for the detection of microembolic signals (MESs), which might be associated with an increased risk of cerebrovascular events. For instance, the presence of MESs on transcranial Doppler in patients with systemic lupus erythematous (SLE) and antiphospholipid syndrome (APS) is associated with an increased risk of stroke. Therefore, transcranial Doppler could be a useful tool for stroke risk stratification in these patients. Objective Our objective was to evaluate transcranial Doppler cerebral mean blood flow velocities as well as the presence of MESs and RLS in patients with antiphospholipid syndrome and SLE. Patients and methods Twenty-two patients with primary APS (PAPS), 24 patients with secondary APS (SAPS), 27 patients with SLE without APS and 21 healthy controls were evaluated. Clinical and epidemiological data were compiled from medical charts, and all subjects underwent transcranial Doppler examination with breath-holding index calculation. Both middle cerebral arteries were monitored for 60 min for the detection of MESs. RLS was investigated with agitated saline injected as a bolus. Results There were no significant differences in mean blood flow velocities among the groups. MESs were more frequently found in patients with SLE when compared with controls and patients with APS (SLE: 17.4%, SAPS: 4.3%, PAPS: 0%, controls: 0%, p = 0.03). Anticoagulant therapy was more frequently used in the APS group (PAPS: 81.8%, SAPS: 75.2%, SLE: 1.7%, p < 0.001). Patients with APS had a higher frequency of RLS when compared with volunteers (63.6% versus 38.1%, p = 0.05). Breath-holding index values tended to be lower in patients with SAPS than in control subjects and patients with PAPS and SLE ( p = 0.06). Conclusions Patients with APS had a higher frequency of RLS than healthy controls. This finding alerts to the importance of cardiac investigation in patients with stroke and APS, because further therapies such as RLS occlusion might eventually add protection. The higher frequency of MES in patients with SLE could suggest an effect of anticoagulant therapy on MES prevention, more frequently used in patients with APS.

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