Extracranial and Intracranial Ultrasonographic Findings in Posterior Circulation Infarction

Chi, Hsin‐Yi; Hsu, Chung-Fu; Chen, An‐Chih; Su, Ching‐Tzong; Hu, Han‐Hwa; Fu, Wen‐Mei

doi:10.1002/jum.14501

Cited by 15 publications

(21 citation statements)

References 37 publications

(84 reference statements)

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“…Chi et al (13) used 100 mL/min as a cut-off value to show that 72.5% of stroke patients had normal NVAFV. This finding is close to our result of 80.8%.…”

Section: Discussionmentioning

confidence: 99%

Association Between Net Vertebral Artery Flow Volume and Non-AF Stroke: A Retrospective 2-Year Analysis

et al. 2019

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Objectives: Association between net vertebral artery flow volume (NVAFV) and stroke types remains unclear. We hypothesize NVAFV is low in patients with posterior circulation infarction (PCI) and an ideal cut-off value for discriminating PCI from anterior circulation infarction (ACI) and controls may be present.Materials and Methods: As study candidates, we retrospectively enrolled hospitalized patients with first-time non-AF stroke within 2-years period. Consecutive non-AF, non-stroke subjects were enrolled as the control group. We compared NVAFV values among the PCI, ACI, and control groups.Results: Overall, 866 candidates—213, 418, and 235 candidates in the PCI, ACI, and control groups, respectively—were enrolled. NVAFV (mean ± SD) values were 134.8 ± 52.7, 152.3 ± 59.2, and 172.0 ± 54.7 mL/min in the PCI, ACI, and control groups, respectively. Statistics revealed significant difference (p < 0.001) among three groups. To use NVAFV as a diagnostic parameter, the AUC of any two groups should be between 0.58 and 0.69. Most (93.6%) of the controls had NVAFV above 100 mL/min. The odds ratio of any non-AF stroke is 3.48 if the NVAFV is below 100 mL/min.Conclusions: NVAFV is lowest in non-AF PCI group. Low NVAFV is associated with both non-AF ACI and PCI. No ideal cut-off value is available to discriminate PCI from other two conditions. We agree that an NVAFV of 100 mL/min is the lower limit of a normal value. Any value below 100 mL/min indicates high stroke risk and implies diffuse cerebral atherosclerosis and impaired cerebral perfusion.

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“…Chi et al (13) used 100 mL/min as a cut-off value to show that 72.5% of stroke patients had normal NVAFV. This finding is close to our result of 80.8%.…”

Section: Discussionmentioning

confidence: 99%

Association Between Net Vertebral Artery Flow Volume and Non-AF Stroke: A Retrospective 2-Year Analysis

et al. 2019

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“…Hypoperfusion determined using large-vessel quantitative magnetic resonance angiography is closely associated with the risk of stroke in patients with symptomatic atherosclerotic vertebral basilar artery occlusive disease [11]. TCD demonstrated a decreasing trend of blood ow velocity in patients with PCCI, indicating that hypoperfusion is an important factor leading to an infarction in the posterior circulation [21]. TCD is a non-invasive measure of intracranial CBF velocity, which is usually associated with changes in blood ow [22].…”

Section: Discussionmentioning

confidence: 99%

Transcranial Doppler combined with quantitative electroencephalography brain function monitoring for estimating the prognosis of patients with posterior circulation cerebral infarction

Cao

Song

Wang

et al. 2020

Preprint

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Background: Posterior circulation cerebral infarction (PCCI) leads to decreased cerebral blood flow (CBF) and metabolism. Neural activity is closely related to regional CBF both spatially and temporally. Transcranial Doppler (TCD) combined with quantitative electroencephalography (QEEG) can evaluate neurovascular coupling and involves synergy between the metabolic and vascular systems. This study aimed to monitor brain function using TCD-QEEG and estimate its efficacy in predicting the prognosis of patients with PCCI.Methods: We used TCD-QEEG to perform quantitative brain function monitoring; we recorded the related clinical variables simultaneously. The data were analyzed using a Cox proportional hazards regression model. Receiver-operating characteristic (ROC) curve analysis was used to evaluate the cut-off for the diastolic flow velocity (VD) and (delta+theta)/(alpha+beta) ratio (DTABR). The area under the ROC curve (AUROC) was calculated to assess the predictive validity of the study variables. Results: Forty patients (aged 63.7±9.9 years; 30 men) were assessed. Mortality at 90 days was 40%. The TCD indicators of VD (hazards ratio [HR] 0.168, confidence interval [CI] 0.047–0.597, p=0.006), and QEEG indicators of DTABR (HR 12.527, CI 1.637–95.846, p=0.015) were the independent predictors of the clinical outcomes. The AUROC after the combination of VD and DTABR was 0.896 and showed better predictive accuracy than the Glasgow Coma Scale score (0.75), VD (0.76), and DTABR (0.781; all p<0.05).Conclusion: TCD-QEEG provides a good understanding of the coupling mechanisms in the brain and can improve our ability to predict the prognosis of patients with PCCI.

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“…The researchers believe that this is due to compensation by the contralateral vertebral artery to ensure normal cerebral perfusion. [19] Our study compared the effect of two different treatment methods on the hemodynamics of the vertebral-basal artery. The results showed that the PSV, EDV in the stenotic vertebral artery and PSV in the basilar artery were significant higher in the stenting group than in the drug treatment group.…”

Section: Discussionmentioning

confidence: 99%

Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis

Shao

Ling

et al. 2019

Medicine

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This study aimed to compare the clinical efficacy of stenting compared with standardized medical treatment in patients with moderate to severe vertebral artery origin stenosis (VAOS). Patients diagnosed with moderate to severe VAOS and indicated to undergo vertebral artery stenting were enrolled. Patients were divided into stenting group and standardized medical treatment group. All patients underwent transcranial Doppler (TCD) before and after treatment. Incidence of new cerebral infarction, transient ischemic attack (TIA), improvement of clinical symptoms, and National Institutes of Health Stroke Scale (NIHSS) score were observed. A total of 98 patients were enrolled. Vertebral artery stenting implant was accepted by 43 patients. Two weeks after treatment, the NIHSS score in the stenting group decreased significantly compared to that in the standardized medical treatment group. The modified Rankin Scale (mRS) score in the stenting group at three months was significantly lower than that in the medical treatment group ( P = .044). The extent of vascular stenosis in the stent group decreased significantly (76.5 ± 10.0% vs. 13.7 ± 5.9%, t = 35.878, P = .000). The adverse events occurred in 9 (16.4%) patients in the medical treatment group and 5 (11.6%) in the stenting group ( P = .506). There was one case with new cerebral infarction in the stenting group, whereas the medical treatment group showed 1 case with TIA and three with new cerebral infarction during follow-up after 3 months. The peak systolic velocity (PSV), end diastolic velocity (EDV), pulsatility index (PI) of stenosis vertebral artery, and PSV of basilar artery were significantly higher in the stent group than those in the standardized medical group ( P < .05). Stenting for VAOS, rather than standardized medical treatment, can effectively relieve vascular stenosis, alter vertebral-basilar artery hemodynamics, and improve neurological function, with low perioperative complications.

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Extracranial and Intracranial Ultrasonographic Findings in Posterior Circulation Infarction

Abstract: Vertebral artery hypoplasia and a low velocity in the intracranial vertebrobasilar system on US might change the treatment of patients with posterior circulation infarction for primary and secondary prevention.

Cited by 15 publications

References 37 publications

Association Between Net Vertebral Artery Flow Volume and Non-AF Stroke: A Retrospective 2-Year Analysis

Association Between Net Vertebral Artery Flow Volume and Non-AF Stroke: A Retrospective 2-Year Analysis

Transcranial Doppler combined with quantitative electroencephalography brain function monitoring for estimating the prognosis of patients with posterior circulation cerebral infarction

Comparison of hemodynamic changes and prognosis between stenting and standardized medical treatment in patients with symptomatic moderate to severe vertebral artery origin stenosis

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