| Objective: In order to pinpoint whether the Cerebral blood flow autoregulation (CA)is damaged in patients with severe carotid artery stenosis or occlusion, and toevaluate the prognosis of stroke, we use Transcranial Doppler (TCD) combined withposture change to monitor their CBFV on their bilateral middle cerebral artery(MCA).Method: The study selected patients with severe carotid artery stenosis or occlusion,and made a comparison of their blood flow velocity changes in middle cerebralartery as well as the duration of each waveform in patients’ uninjured side andinjured side using TCD when they change from supine position to the uprightposition. To observe whether the Cerebral blood flow autoregulation is changed, wecompared the cerebral blood flow velocity (CBFV) differences and the duration ofthe x-w wave between the injured and uninjured side. Besides, we made regular stroke recovery follow-ups and gave MRS scores to see whether the supine-standingCBFV changes are related with stroke recovery. The patients were divided into twogroups (Symptomatic and asymptomatic group).We observe the supine-standingCBFV changes、the level and the type of the collateral circulation at the injured sidein the two groups,to define the compensatory of cerebral blood flow.Results:1.supine-standing CBFV changes: in the normal control group were(2.57±3.350)cm/s；in the severe carotid artery stenosis or occlusion group were(5.69±5.545)cm/s, in the uninjured side were (3.70±3.442) cm/s, the differences weregreater in the injured side than in the contralateral, p <0.005; there are no statisticaldifferences between the uninjured and normal control group, p>0.05.2. X-W waveinterval: in the injured side of the severe carotid artery stenosis or occlusion groupwere （22.42±4.769）s, the uninjured side were （21.12±4.394）s, p<0.001.3. Thesupine-standing CBFV changes in the asymptomatic group were（2.76±3.388）cm/s, inthe symptomatic group were（8.59±5.639）cm/s, the differences in the asymptomaticwere less than the symptomatic, p<0.05; all of the29（100%）asymptomatic showed collateral circulation, in the symptomatic there were24(75%) individuals performingcollateral circulation, multiple collateral circulations were appeared79%in theasymptomatic, and44%in the symptomatic, the multiple lateral branches open ratewere higher in the asymptomatic than the symptomatic, p<0.05;The number of theanterior communicating artery,the posterior communicating artery the externalcarotid artery to internal carotid artery was20(69%),15(52),12(41%) respectively inthe asymptomatic, and in the symptomatic was14(44%),13(41%),15(47%);theACOA open rate were significantly higher in the asymptomatic than the symptomatic（p<0.05）,but there were no significant differences between PCOA andECA-ICA(p>0.05);4. The supine-standing CBFV changes in the injured side had anpositive correlation with the MRS scores(r>0).Conclusion:1The cerebral blood flow autoregulation (CA) is damaged in thesevere carotid artery stenosis or occlusion patients.2The supine-standing CBFV changes are larger in the symptomatic than the asymptomatic.This indicates that the symptomatic patients have a bad cerebral bloodflow autoregulation than the symptomatic, and the blood flow compensatorymechanism is incomplete.3Compared with the symptomatic group, the asymptomatic group has a higher openrate of the collateral circulation and the multiple collateral circulations.4The supine-standing CBFV changes had a certain influence on the prognosis of thestroke... |
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