Evaluation of intracranial collateral circulation in patients with chronic middle cerebral artery occlusion with transcranial color Doppler ultrasonography

Objectives To investigate the value of intracranial collateral circulation in patients with chronic middle cerebral artery (MCA) occlusion with transcranial color Doppler ultrasonography (TCD) and to establish the indicators of hemodynamic parameter and assess their accuracy.Methods A total of 140 consecutive patients with unilateral MCA occlusion diagnosed by digital subtraction angiography (DSA) in the Departments of Neurology and Neurosurgery, Xuan Wu Hospital, Capital Medical University, Beijing, China were included from September 2008 to February 2010.According to the leptomeningeal branch compensation showed on DSA, the patients were divided into no compensation (n =21) , simple anterior cerebral artery (ACA) compensation (n = 43) , simple posterior cerebral artery (PCA) compensation (n =28) , and ACA + PCA compensation (n =48) groups.TCD was used to detect the peak systolic velocity (PSV) of bilateral MCA, anterior cerebral artery (ACA) , and posterior cerebral artery (PCA).The ratios of ACA peak velocity on the ipsilateral side (d) and MCA peak velocity on the contralateral side (n) (dPSV_(ACA)/nPSV_(MCA)) , the ratios of ACA peak velocity on the ipsilateral side and ACA peak velocity on the contralateral side (dPSV_(ACA)/nPSV_(ACA)), as well as the ratios of PCA peak velocity on the ipsilateral side and PCA peak velocity on the contralateral side (dPSV_(PCA)/nPSV_(PCA)) were calculated.Taking ACA and PCA leptomeningeal branches open or not showed on DSA as a reference standard, the ROC curve was used to establish the optimal boundary values of hemodynamic parameters for evaluating ACA and PCA in participation of compensation, and the sensitivity, specificity, and accuracy were assessed.Results ①The dPSV_(ACA)/nPSV_(MCA) in the simple ACA compensation and ACA + PCA compensation groups were 1.341 ± 0.348 and 1.337 ±0.403 respectively, which were significantly higher than 0.883 ±0.256 in the no ACA compensation group.The dPSV_(ACA)/nPSV_(ACA) in the simple ACA compensation and ACA + PCA compensation groups were 1.660 ±0.753 and 1.670 ±0.404 respectively, which were significantly higher than 0.978 ±0.259 in the no ACA compensation group.The dPSV_(PCA)/nPSV_(PCA) in the simple PCA compensation and ACA + PCA compensation groups were 1.758 ±0.560 and 1.735 ±0.486 respectively, which were significantly higher than 1.210 ±0.336 in the no PCA compensation group.② The dPSV_(ACA)/nPSV_(MCA) ≥1.20 and dPSV_(ACA)/nPSV_(ACA) ≥1.25 were used as the optimal cutoff values of ACA compensation, and their accuracy were 65.7% and 78.5% respectively.The dPSV_(PCA)/nPSV_(PCA) 3= 1.45 were used as the optimal cutoff values of PCA compensation, and its accuracy was 75.0%.Conclusions TCD can be used as an examination method for evaluating ACA and PCA leptomeningeal branch compensation ability in patients with MCA occlusion. Establishment of TCD hemodynamic parameters has important clinical value for accurately assessing the status and prognosis of collateral circulation in patients with MCA occlusion.