ART OF MEDICINE 2017

 

FEATURES OF CEREBRAL HEMODYNAMICS IN PATIENTS AFTER ATHEROTROMBOTIC ISCHEMIC STROKE

V.R. Gerasymchuk1, V. A. Gryb1, O. M. Gerasymchuk2

            1SHEI “Ivano-Frankivsk National Medical University”,

            2Ivano-Frankivsk Central Clinical Hospital, This email address is being protected from spambots. You need JavaScript enabled to view it.

 

Abstract

Summary. The prevalence of acute cerebrovascular accidents in the world remains high and ranges from 100 to 500 cases per 100,000 population, about 57% of which is ischemic stroke (IS). One of the prerequisites for effective recovery is the normalization of cerebral hemodynamics and the providing of adequate perfusion of intact cortical units for the complete realization of their neuroplastic potential.

The aim of the study was to investigate the features of arterial and venous components of cerebral hemodynamics in patients after first-ever hemispheric atherothrombotic IS.

147 patients in the early recovery period of the first-ever hemispheric atherothrombotic IS were examined. The research was carried out in departments of the vascular neurology of Ivano-Frankivsk Regional Clinical Hospital and Ivano-Frankivsk Central City Clinical Hospital. The control group (CG) consisted of 20 practically healthy individuals. Ultrasound duplex scan of extra- and intracranial vessels was performed using the Esaote My Lab 30 (Italy). Statistical processing of the obtained results was carried out with the help of statistical analysis software Statistica 6.0 (StatSoft, USA) and MS Excel 2010 using nonparametric methods.

In examined patients the IS was localized in the left brain hemisphere (LHS) in 80 (54.4%) patients (among which 76 (51.7%) cases were in the region of the left middle cerebral artery (MCA), and 4 (2.7%) in the region of left anterior cerebral artery (ACA)), and in 67 (45.6%) patients it was localized in the right hemisphere (RHS) (among which 65 (44.2%) cases were in the region of right MCA, and 2 (1.4%) were in the region of right ACA).

Disorders of cerebral hemodynamics in examined patients manifestated in the decrease of peak velocity (Vps), increase of pulsatory (PI) and resistance (RI) indices in ipsy- and contralateral common (CCA) and internal (ICA) carotid arteries, and the increase of CCA intima-media complex thickness in comparison with the CG (p<0.05). During investigation of intracranial hemodynamics the decrease of Vps in the anterior circulation vessels, accompanied by increased circulatory resistance indices compared to the CG, were observed (p<0.05).

Examination of the venous component of cerebral hemodynamics revealed the Vps increase to 56.9% in the left Rosenthal vein (RV), and its increase to 35.3% in the rectus sinus (RS), in comparison with the CG (p<0.05) in patients with LHS. In patients with RHS the Vps in the right RV was increased to 49.0%, and in the RS it was increased to 45.1% (p<0.05). During analysis of the influence of arterial hemodynamics on the venous one the inverse correlation between the Vps in RS and Vps in ipsilateral to IS MCA was found at LHS (r=-0.43; p= 0.036) and at RHS (r=-0.51; p=0.014), as well as correlation between the ipsilateral RV and MCA Vps at LHS (r=-0.31; p=0.044) and RHS (r=-0.33; p=0.039). At the same time, the increase in RI in ICA bifurcation was accompanied by an increase in the ipsilateral RV blood filling at LHS (r=0.27; p=0.042) and RHS (r=0.31; p=0.043).

Conclusions. 1. The changes of the venous component of cerebral hemodynamics, manifested in the Vps increase in the RV ans RS, are characteristic for patients after first-ever hemispheric atherothrombotic IS.

  1. Manifestations of the venous discirculation tend to grow on the background of Vps decrease and the RI increase in the ICA and MCA.

Key words: ischemic stroke, cerebral hemodynamics, treatment.

 

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