Department of Neurosurgery (C.H.B.v.N., M.S., GE, M.H., A.H., L.R., J.F.), University Hospital Zurich, University of Zurich, Switzerland.
Clinical Neuroscience Center (C.H.B.v.N., M.S., S.W., G.E., M.H., A.H., C.S., A.R.L., L.R., J.F.), University Hospital Zurich, University of Zurich, Switzerland.
Stroke. 2021 Apr;52(4):1469-1472. doi: 10.1161/STROKEAHA.120.032848. Epub 2021 Mar 9.
Increased Transcranial Doppler flow velocity in the ipsilateral P2-segment of the posterior cerebral artery (PCA-P2: cm/second) is associated with recurrent cerebrovascular events in patients with unilateral internal carotid artery occlusion. However, its predictive value and correlation with hemodynamic impairment in an overall stroke patient cohort remains to be determined.
Transcranial doppler PCA-P2 flow velocity was measured in 88 patients with symptomatic unilateral steno-occlusive disease who also underwent blood oxygenation-level dependent cerebrovascular reactivity imaging (blood oxygenation-level dependent [BOLD]-cerebrovascular reactivity [CVR]). A multivariate linear regression was used to evaluate the independent correlation between the ipsilateral PCA-P2 flow velocity measurements and hemispheric BOLD-CVR. Follow-up BOLD-CVR imaging data, available in 25 patients, were used to evaluate the temporal evolution of the BOLD-CVR and PCA-P2 flow velocity association using a mixed-effect model. Furthermore, a transcranial doppler cutoff for hemodynamic failure stage 2 was determined.
The ipsilateral systolic PCA-P2 flow velocity strongly correlated with hemispheric BOLD-CVR (R=0.79; R=0.61), which remained unchanged when evaluating the follow-up data. Using a PCA-P2 systolic flow velocity cutoff value of 85 cm/second, patients with BOLD-CVR based hemodynamic failure stage 2 were diagnosed with an area under the curve of 95.
In patients with symptomatic unilateral steno-occlusive disease, increased ipsilateral transcranial doppler PCA-P2 systolic flow velocity independently correlates with BOLD-CVR based hemodynamic failure. A cutoff value of 85 cm/second appears to indicate hemodynamic failure stage 2, but this finding needs to be validated in an independent patient cohort.
颈内动脉单侧闭塞患者，大脑后动脉（PCA）P2 段（cm/秒）同侧颅内外多普勒血流速度增加与复发性脑血管事件相关。然而，其在总体卒中患者人群中的预测价值及其与血液动力学损害的相关性仍有待确定。
对 88 例症状性单侧狭窄性疾病患者进行了经颅多普勒 PCA-P2 血流速度测量，这些患者还进行了血氧水平依赖脑血管反应性成像（BOLD-脑血管反应性 [CVR]）。采用多元线性回归来评估同侧 PCA-P2 血流速度测量与半球 BOLD-CVR 之间的独立相关性。在 25 例患者中获得了随访的 BOLD-CVR 成像数据，使用混合效应模型来评估 BOLD-CVR 和 PCA-P2 血流速度相关性的时间演变。此外，确定了用于诊断血液动力学衰竭 2 期的经颅多普勒截止值。
同侧收缩期 PCA-P2 血流速度与半球 BOLD-CVR 强烈相关（R=0.79；R=0.61），当评估随访数据时，这种相关性保持不变。使用 PCA-P2 收缩期血流速度截止值 85cm/秒，根据 BOLD-CVR 诊断为血液动力学衰竭 2 期的患者的曲线下面积为 95。
在症状性单侧狭窄性疾病患者中，同侧经颅多普勒 PCA-P2 收缩期血流速度增加与基于 BOLD-CVR 的血液动力学衰竭独立相关。85cm/秒的截止值似乎表明存在血液动力学衰竭 2 期，但这一发现需要在独立的患者队列中得到验证。
