Peripheral Vascular Resistance in Cerebral Arteries in Patients With Carotid Atherosclerosis - Substudy Results of the Atherosclerotic Plaque Characteristics Associated With a Progression Rate of the Plaque and a Risk of Stroke in Patients With the Carotid Bifurcation Plaque Study (ANTIQUE)
Language English Country Great Britain, England Media print-electronic
Document type Journal Article
Grant support
17-31016A
Ministerstvo Zdravotnictví Ceské Republiky
PubMed
33792942
DOI
10.1002/jum.15703
Knihovny.cz E-resources
- Keywords
- atherosclerosis, plaque, pulsatility, resistance, transcranial Doppler,
- MeSH
- Cerebral Arteries MeSH
- Plaque, Atherosclerotic * MeSH
- Stroke * MeSH
- Vascular Resistance MeSH
- Middle Aged MeSH
- Humans MeSH
- Carotid Artery Diseases * complications diagnostic imaging MeSH
- Aged MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged MeSH
- Publication type
- Journal Article MeSH
OBJECTIVES: Transcranial color-coded duplex sonography (TCCS) enables to measure blood flow characteristics in cerebral vessels, including vascular resistance and pulsatility. The study aims to identify factors influencing pulsatility (PI) and resistance (RI) indices measured using TCCS in patients with carotid atherosclerosis. METHODS: Self-sufficient patients with atherosclerotic plaque causing 20-70% carotid stenosis were consecutively enrolled to the study. All patients underwent duplex sonography of cervical arteries and TCCS with measurement of PI and RI in the middle cerebral artery, neurological, and physical examinations. Following data were recorded: age, gender, height, weight, body mass index, systolic and diastolic blood pressure, occurrence of current and previous diseases, surgery, medication, smoking, and daily dose of alcohol. Univariant and multivariant logistic regression analysis were used for identification of the factors influencing RI and PI. RESULTS: Totally 1863 subjects were enrolled to the study: 139 healthy controls (54 males, age 55.52 ± 7.05 years) in derivation cohort and 1724 patients (777 males, age 68.73 ± 9.39 years) in validation cohort. The cut off value for RI was 0.63 and for PI 1.21. Independent factors for increased RI/PI were age (odds ratio [OR] = 1.108/1.105 per 1 year), occurrence of diabetes mellitus (OR = 1.767/2.170), arterial hypertension (OR = 1.700 for RI only), width of the carotid plaque (OR = 1.260 per 10% stenosis for RI only), and male gender (OR = 1.530 for PI only; P ˂.01 in all cases). CONCLUSIONS: The independent predictors of increased cerebral arterial resistance and/or pulsatility in patients with carotid atherosclerosis were age, arterial hypertension, diabetes mellitus, carotid plaque width, and male gender.
Center for Health Research Ostrava University Medical Faculty Ostrava Czech Republic
Department of Neurology Stroke Center Vítkovice Hospital Ostrava Czech Republic
See more in PubMed
Bartels E, Fuchs H-H, Flügel KA. Color Doppler imaging of basal cerebral arteries: normal reference values and clinical applications. Angiology 1995; 46:877-884.
Tsivgoulis G, Sharma VK, Lao AY, Malkoff MD, Alexandrov AV. Validation of transcranial Doppler with computed tomography angiography in acute cerebral ischemia. Stroke 2007; 38:1245-1249.
Malojcic B, Giannakopoulos P, Sorond FA, et al. Ultrasound and dynamic functional imaging in vascular cognitive impairment and Alzheimer's disease. BMC Med 2017; 15:27.
Christou I, Felberg RA, Demchuk AM, et al. A broad diagnostic battery for bedside transcranial Doppler to detect flow changes with internal carotid artery stenosis or occlusion. J Neuroimaging 2001; 11:236-242.
Alexandrov AV, Sloan MA, Tegeler CH, et al. Practice standards for transcranial Doppler (TCD) ultrasound. Part II. Clinical indications and expected outcomes. J Neuroimaging 2012; 22:215-224.
Tegeler CH, Crutchfield K, Katsnelson M, et al. Transcranial doppler velocities in a large, healthy population. J Neuroimaging 2013; 23:466-472.
Altmann M, Thommessen B, Rønning OM, Benth JS, Reichenbach AS, Fure B. Middle cerebral artery pulsatility index is associated with cognitive impairment in lacunar stroke. J Neuroimaging 2016; 26:431-435.
Fu S, Zhang J, Zhang H, Zhang S. Predictive value of transcranial doppler ultrasound for cerebral small vessel disease in elderly patients. Arq Neuropsiquiatr 2019; 77:310-314.
Wardlaw JM, Smith C, Dichgans M. Small vessel disease: mechanisms and clinical implications. Lancet Neurol 2019; 18:684-696.
Abdelrasoul AA, Elsebaie NA, Gamaleldin OA, Khalifa MH, Razek AAKA. Imaging of brain infarctions: beyond the usual territories. J Comput Assist Tomogr 2019; 43:443-451.
Wardlaw JM, Smith EE, Biessels GJ, et al. Neuroimaging standards for research into small vessel disease and its contribution to ageing and neurodegeneration: a united approach. Lancet Neurol 2013; 12:822-838.
van Veluw SJ, Shih AY, Smith EE, et al. Detection, risk factors, and functional consequences of cerebral microinfarcts. Lancet Neurol 2017; 16:730-740.
Bos D, Wolters FJ, Darweesh SKL, et al. Cerebral small vessel disease and the risk of dementia: a systematic review and meta-analysis of population-based evidence. Alzheimers Dement 2018; 14:1482-1492.
Lee KY, Sohn YH, Baik JS, Kim GW, Kim JS. Arterial pulsatility as an index of cerebral microangiopathy in diabetes. Stroke 2000; 31:1111-1115.
Park KY, Chung PW, Kim YB, Moon HS, Suh BC, Yoon WT. Increased pulsatility index is associated with intracranial arterial calcification. Eur Neurol 2013; 69:83-88.
Pantoni L. Cerebral small vessel disease: from pathogenesis and clinical characteristics to therapeutic challenges. Lancet Neurol 2010; 9:689-701.
Shi Y, Thrippleton MJ, Marshall I, Wardlaw JM. Intracranial pulsatility in patients with cerebral small vessel disease: a systematic review. Clin Sci 2018; 132:157-171.
Sharma VK, Tsivgoulis G, Lao AY, Malkoff MD, Alexandrov AV. Noninvasive detection of diffuse intracranial disease. Stroke 2007; 38:3175-3181.
Sabayan B, Jansen S, Oleksik AM, et al. Cerebrovascular hemodynamics in Alzheimer's disease and vascular dementia: a meta-analysis of transcranial Doppler studies. Ageing Res Rev 2012; 11:271-277.
Purkayastha S, Fadar O, Mehregan A, et al. Impaired cerebrovascular hemodynamics are associated with cerebral white matter damage. J Cereb Blood Flow Metab 2014; 34:228-234.
Chambless LE, Folsom AR, Davis V, et al. Risk factors for progression of common carotid atherosclerosis: the atherosclerosis risk in communities study, 1987-1998. Am J Epidemiol 2002; 155:38-47.
Crouse JR, Toole JF, McKinney WM, et al. Risk factors for extracranial carotid artery atherosclerosis. Stroke 1987; 18:990-996.
Spence JD, Hackam DG. Treating arteries instead of risk factors: a paradigm change in management of atherosclerosis. Stroke 2010; 41:1193-1199.
Sidhu PS, Allan PL. The extended role of carotid artery ultrasound. Clin Radiol 1997; 52:643-653.
Schmidt R, Fazekas F, Enzinger C, Ropele S, Kapeller P, Schmidt H. Risk factors and progression of small vessel disease-related cerebral abnormalities. J Neural Transm Suppl 2002; 62:47-52.
von Reutern G-M, Goertler M-W, Bornstein NM, et al. Grading carotid stenosis using ultrasonic methods. Stroke 2012; 43:916-921.
Beishon L, Haunton VJ, Panerai RB, Robinson TG. Cerebral hemodynamics in mild cognitive impairment: a systematic review. J Alzheimers Dis 2017; 59:369-385.
Feldmann E, Wilterdink JL, Kosinski A, et al. The stroke outcomes and neuroimaging of intracranial atherosclerosis (SONIA) trial. Neurology 2007; 68:2099-2106.
Velcheva I, Titianova E, Antonova N. Evaluation of the hemorheological and neurosonographic relationship in patients with cerebrovascular diseases. Clin Hemorheol Microcirc 2004; 30:373-380.
Schaafsma A. Improved parameterization of the transcranial Doppler signal. Ultrasound Med Biol 2012; 38:1451-1459.
Rosenkranz K, Langer R, Felix R. Transcranial Doppler sonography: collateral pathways in internal carotid artery obstructions. Angiology 1991; 42:819-826.
Heyer EJ, Mergeche JL, Connolly ES. Middle cerebral artery pulsatility index and cognitive improvement after carotid endarterectomy for symptomatic stenosis. J Neurosurg 2014; 120:126-131.
Ackerstaff RGA, Keunen RWM, van Pelt W, van Swijndregt ADM, Stijnen T. Influence of biological factors on changes in mean cerebral blood flow velocity in normal ageing: a transcranial Doppler study. Neurol Res 1990; 12:187-191.
Yang D, Cabral D, Gaspard EN, Lipton RB, Rundek T, Derby CA. Cerebral hemodynamics in the elderly. J Ultrasound Med 2016; 35:1907-1914.
Krejza J, Szydlik P, Liebeskind DS, et al. Age and sex variability and normal reference values for the VMCA/VICA index. Am J Neuroradiol 2005; 26:730-735.
Reeves MJ, Bushnell CD, Howard G, et al. Sex differences in stroke: epidemiology, clinical presentation, medical care, and outcomes. Lancet Neurol 2008; 7:915-926.
Schmieder RE, Schmidt BM, Raff U, et al. Cerebral microangiopathy in treatment-resistant hypertension. J Clin Hypertens 2011; 13:582-587.
Aboyans V, Lacroix P, Criqui MH. Large and small vessels atherosclerosis: similarities and differences. Prog Cardiovasc Dis 2007; 50:112-125.
Fulesdi B, Limburg M, Bereczki D, et al. Impairment of cerebrovascular reactivity in long-term type 1 diabetes. Diabetes 1997; 46:1840-1845.
Cho SJ, Sohn YH, Kim GW, Kim J-S. Blood flow velocity changes in the middle cerebral artery as an index of the chronicity of hypertension. J Neurol Sci 1997; 150:77-80.
Czosnyka M, Richards HK, Whitehouse HE, Pickard JD. Relationship between transcranial Doppler-determined pulsatility index and cerebrovascular resistance: an experimental study. J Neurosurg 1996; 84:79-84.
Farhoudi M, Mehrvar K, Aslanabadi N, Ghabili K, Baghmishe NR, Ilkhchoei F. Doppler study of cerebral arteries in hypercholesterolemia. Vasc Health Risk Manag 2011; 7:203-207.
Lin YP, Fu MH, Tan TY. Factors associated with no or insufficient temporal bone window using transcranial color-coded sonography. J Med Ultrasound 2015; 23:129-132.
Razek AAKA, Fouda NS, Elmetwaley N, Elbogdady E. Sonography of the knee joint. J Ultrasound 2009; 12:53-60.
