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Increased pulsatility of the intracranial blood flow spectral waveform on transcranial Doppler does not point to peripheral arterial disease in stroke patients

Barlinn, Kristian
Autor Barlinn, Kristian Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany. Electronic address: kristian.barlinn@uniklinikum-dresden.de
Kolieskova, Stanislava
Autor Kolieskova, Stanislava Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama International Clinical Research Centre, St. Anne's University Hospital, Brno, Czech Republic Neurology Department, Masaryk University, Brno, Czech Republic
Shahripour, Reza Bavarsad
Autor Shahripour, Reza Bavarsad Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama
Kepplinger, Jessica
Autor Kepplinger, Jessica Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
Boehme, Amelia K
Autor Boehme, Amelia K Department of Epidemiology, School of Public Health, University of Alabama Hospital, Birmingham, Alabama
Siepmann, Timo
Autor Siepmann, Timo Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
Puetz, Volker
Autor Puetz, Volker Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
Bodechtel, Ulf
Autor Bodechtel, Ulf Dresden University Stroke Center, Department of Neurology, University Hospital Carl Gustav Carus Dresden, University of Technology Dresden, Dresden, Germany
Jordan, William D
Autor Jordan, William D Department of Vascular Surgery, University of Alabama Hospital, Birmingham, Alabama
Alexandrov, Andrei V
Autor Alexandrov, Andrei V Department of Neurology, Comprehensive Stroke Center, University of Alabama Hospital, Birmingham, Alabama Department of Neurology, The University of Tennessee Health Science Center, Memphis, Tennessee

Journal of stroke and cerebrovascular diseases. 2015 ; 24 (1) : 189-95. [pub] 20141106

J Stroke Cerebrovasc Dis
ISSN 1532-8511
Medvik
Zdroj

BACKGROUND: Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. METHODS: We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to .75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to .9 or more was considered predictive of definite PAD. RESULTS: We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P = .60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR], .68; 95% CI, .22-2.12; P = .51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P = .002 and OR, 3.20; 95% CI, 1.51-6.77; P = .002, respectively). CONCLUSIONS: Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.

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