Middle Cerebral Artery Pulsatility Is Highly Associated with Systemic Blood Viscosity in Acute Ischemic Stroke within 24 Hours of Symptom Onset

Han, Ji Eun; Park, Joong Hyun; Baik, Jong Sam; Kim, Jeong Yeon; Park, Jae Hyeon; Han, Sang Won; Yu, Hyun-Jeung

doi:10.31728/jnn.2019.00050

Cited by 8 publications

(6 citation statements)

References 18 publications

(33 reference statements)

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“…We previously reported that middle cerebral artery (MCA) pulsatility is highly associated with systemic blood viscosity (BV) in acute ischemic stroke within 24 hours of symptom onset. 1 Our findings indicated that transcranial Doppler (TCD) pulsatility index (PI) is a useful non-invasive imaging modality for exploring the viscosity of cerebral vessels. We also showed that prior antithrombotic use was significantly associated with decreased BV in acute ischemic stroke patients.…”

Section: Ntroductionmentioning

confidence: 87%

“…BV is uniform over a short period of time and TCD PI is influenced by several physiological factors. 1 One study demonstrates that BV at admission is significantly higher in patients with lacunar stroke but drops after 2 weeks of normal hydration. 3 Our previous study also shows that PIs decreased in the first 14 days after the lacunar stroke.…”

Section: Discussionmentioning

confidence: 99%

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The Relationship between Changes in Systemic Blood Viscosity and Transcranial Doppler Pulsatility in Lacunar Stroke

Han

Joong-Hyun

et al. 2020

J Neurosonol Neuroimag

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Background:We hypothesized that changes in blood viscosity (BV) would influence cerebral vessel viscosity, which is related to the transcranial Doppler (TCD) pulsatility index (PI). Using serial BV and TCD examinations, we sought to evaluate the relationship between changes in BV and TCD PI in lacunar stroke patients. Methods: Patients (aged ≥50 years) who developed lacunar stroke within 7 days of symptom onset were enrolled. Laboratory tests and TCD examinations were conducted at admission and 180 (±30) days after the onset of stroke. Patients were categorized into the decreased BV and increased BV groups. Decreased BV suggested that the BV value in the baseline study minus the 180-day study was positive, and vice-versa. Results: A total of 128 patients who had experienced classic lacunar syndromes were enrolled and 67 (52%) were included in the final analysis. At the end of the 180-day study, changes in systolic BV (SBV) were not associated with PI changes. Regarding diastolic BV (DBV), hematocrit (Hct) adjusted partial correlation analysis showed no significant relationship between changes in DBV and PI (r=0.25, p=0.068). The correlation analysis showed that changes in hemoglobin and Hct were positively associated with SBV and DBV changes (r>0.488, p<0.0001 and r>0.461, p<0.0001), confirming that Hct was the major determinant factor of BV. Conclusion: This study did not show a relationship between changes in BV and cerebral arterial pulsatility in patients with lacunar stroke. The changes in BV were positively associated with changes in Hct.

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Section: Ntroductionmentioning

confidence: 87%

Section: Discussionmentioning

confidence: 99%

The Relationship between Changes in Systemic Blood Viscosity and Transcranial Doppler Pulsatility in Lacunar Stroke

Han

Joong-Hyun

et al. 2020

J Neurosonol Neuroimag

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“…Nevertheless, the use of TCD as a screening tool for high ICP when deciding on operating, placing an ICP catheter or shunting 18,23 seems to be more reliable than using TCD as a surrogate technique after these procedures 24,25 . Furthermore, when interpreting the PI in the setting of acute brain injuries one should take into account that other factors may increase the PI, as aging 26 , diabetes 27 , arterial hypertension 28 , sepsis 29 , dehydration and blood viscosity 30 , oxygenation 31 and sedatives as barbiturates 32 for example. Thus, PI elevation may be a better indicator of some degree of CPP reduction than a surrogate marker for IH 33,34 .…”

Section: Discussionmentioning

confidence: 99%

Improved Transcranial Doppler Waveform Analysis for Intracranial Hypertension Assessment in Patients with Traumatic Brain Injury

Brasil,

Romeijn,

Haspels

et al. 2023

Neurocrit Care

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Background: Transcranial Doppler (TCD) is a noninvasive bedside tool for intracerebral hemodynamic assessments in multiple clinical scenarios. TCD, by means of measuring systolic and diastolic blood velocities allows the calculation of the pulsatility index (PI), a parameter that is correlated with intracranial pressure (ICP). Nevertheless, the predictive value of the PI for raised ICP appears to be low, since it is subjected to several, often confounding factors not related to ICP. Recently, the Pulsatile Apparent Resistance (PaR) was developed as a PI corrected for arterial blood pressure, reducing some of the confounding factors in uencing PI. This study compares the predictive value of PaR versus PI for intracranial hypertension (IH, ICP >20 mmHg) in patients with traumatic brain injury (TBI).Methods: Patients with TBI admitted to the neurocritical care unit who required invasive ICP were included prospectively within ve days of admission. TCD measurements were performed in both middle cerebral arteries, allowing calculations of the PI and PaR. The discriminative power of these parameters for ICP ≥20 mmHg was assessed by calculating the area under the Receiver Operator Characteristics curve (AUC).Results: 93 patients were included. A total of 20 (22%) patients experienced IH. The discriminative power was low for PI (AUC 0.64, 95% Con dence Interval (CI) 0.49 -0.79) and moderate for PaR (AUC 0.75, 95% CI 0.63 -0.86). With regard to subgroup analyses, the discriminative power of these parameters increased after exclusion of patients who had undergone a craniectomy. This was especially true for the PaR (AUC right side 0.88; CI 0,72 -1,0) and PI (AUC right side 0.72; CI 0,44 -1,0). Conclusion:In the present study, discriminative power of the PaR for IH was superior to the PI, especially in patients not having undergone craniectomy. The assessment of PaR may be an adjunct especially for improving timing on a neurosurgical intervention, but also for their monitoring after a neurosurgery is performed. Further studies are warranted to de ne its clinical application. Trial registration: NCT03144219, Registered 01 May 2017 Retrospectively registered, https://www.clinicaltrials.gov/ct2/show/NCT03144219 Take Home Message 1. The transcranial Doppler (TCD) pulsatility index (PI), although being useful to indicate elevation in cerebrovascular resistance, suffers with the in uence of several factors that make this index less accurate in indicating intracranial hypertension (IH).2. The pulsatile apparent resistance (PaR) index was developed to adjust the PI for arterial blood pressure pulsatility, increasing its accuracy compared to the PI.3. The PaR value had a better discriminative power than the PI with regards to IH, with a moderate area under the curve (AUC) for the whole sample, but with a good AUC after exclusion of patients who had undergone craniectomy.

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“…A specify measurement to point out the relationship between stroke and BV is essential. The artery pulsatility is highly associated with blood viscosity in acute ischemic stroke within 24 hours of symptom onset (Han et al, 2019). An appropriate physical measurement model to evaluate the stroke happening risk is observing the viscosity of non-Newtonian property of blood by different shear rate conditions.…”

Section: Introductionmentioning

confidence: 99%

“…The measurement model of the parallel laminar ow is a powerful method for accuracy and precision viscosity detection. Here we used speci c microgeometry to create the blood viscosity measurements with artery pulsatility ow which are simulated by systolic blood viscosity (SBV) and diastolic blood viscosity (DBV) (Han et al, 2019). That provide the in-vitro evaluation system to observing the variable of blood viscosity, one of shear rate conditions, in particular vessel wall for stroke risk factor.…”

Section: Introductionmentioning

confidence: 99%

Microfluidic Platform for Stroke Risk Prediction: Evaluation of Blood Viscosity by Shear Rate Variations

Chang,

Yao

2024

Preprint

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The incidence of stroke is on the rise globally, affecting one in every four individuals each year. An early warning and prevention systems are urgently required. Blood viscosity is a correlation factor that is worthy to study in the stroke risk evaluation model. For the first time, a microfluidic platform was used as the in-vitro blood property evaluation for stroke risk prediction. It can be also used to evaluate the variation of non-Newtonian fluid viscosity under different specific shear rate conditions. The rigorous microarray design is providing the meticulous shear rate which simulating the variable of blood viscosity during pulsation within blood vessels. Furthermore, the systolic blood viscosity (SBV) and diastolic blood viscosity (DBV) can be calculated by using the developed pulsatility flow concept. The results demonstrate an impressive accuracy of 95% and excellent reproducibility while compared to traditional viscometers and rheometer within the human blood viscosity range of 1-10cP. This monitoring system is capable of being an indispensable component in the stroke risk evaluation platform.

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Middle Cerebral Artery Pulsatility Is Highly Associated with Systemic Blood Viscosity in Acute Ischemic Stroke within 24 Hours of Symptom Onset

Cited by 8 publications

References 18 publications

The Relationship between Changes in Systemic Blood Viscosity and Transcranial Doppler Pulsatility in Lacunar Stroke

The Relationship between Changes in Systemic Blood Viscosity and Transcranial Doppler Pulsatility in Lacunar Stroke

Improved Transcranial Doppler Waveform Analysis for Intracranial Hypertension Assessment in Patients with Traumatic Brain Injury

Microfluidic Platform for Stroke Risk Prediction: Evaluation of Blood Viscosity by Shear Rate Variations

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