Correlation Between Eptomeningeal Anastomoses And Cerebral Infarct In Patients With Chronic Middle Cerebral Artery Occlusion

Objective:1.To investigate the hemodynamic changes of extracranial internal carotid artery(ICA)influenced by leptomeningeal anastomoses(LMA)of anterior cerebral artery(ACA)in middle cerebral artery(MCA)chronic occlusion disease.2.To investigate the relationship between LMA of and cerebral infarction areas,and analyze the correlation between MCA velocity and cerebral infarction area.Methods:109 cases with MCA chronic occlusion diagnosed by TCCS and confirmed by DSA were retrospectively and consecutively enrolled during Jan 1 to Dec 2016,all patients had a normal MCA of the other side.All cases were divided into two groups according to DSA result,49 cases in LMA group and 60 cases in non-LMA(NLMA)group.TCCS were used to measure and record peak systolic velocity(PSV),end diastolic velocity(EDV),mean flow velocity(MFV)and resistance index(RI)of bilateral MCA and ACA,the ratio of PSV of contralateral to PSV of ipsilateral was calculated.Color Doppler ultrasound was used to measure and record PSV,EDV and RI of bilateral ICA.The statistical methods were used as follow:1.the hemodynamic parameters of ICA and ACA were compared between ipsilateral and contralateral sides,and were compared between LMA group and NLMA group by means of paired-samples t test and independent-samples t test.2.Linear regression was used to analyze the relevance between parameters of ipsilateral ICA and ACA.3.Receiver operating characteristics(ROC)curve was used for evaluating LMA by the hemodynamic parameters of ipsilateral ACA and ICA.Classification of diffusion-weighted imaging(DWI)was conducted according to the maximal infarction areas by four grades:normal,lacunar infarction,small and moderate infarction,and large infarction.The statistical methods were used as follow:1.Mann-Whitney test was used for comparing the severityof infarction between LMA and NLMA group.2.Spearman rank correlation was used to analyze the correlation of hemodynamic parameters of MCA and infarction area.Results:(1)The percentage of stroke in LMA group was 71.4%(35/49),which was lower than that in NLMA group 90.0%(54/60),the percentage of asymptomatic in LMA group was higher than that in NLMA group(14.3%vs 3.3%,7/49 vs 2/60),the differences were statistically significant(P=0.037).(2)The PSV and EDV of ipsilateral ICA in LMA group were significantly higher than those in NLMA group,and RI was lower(all P<0.01).The PSV and EDV of ipsilateral ACA with LMA were higher than those of contralateral,and RI was lower(all P<0.01).There was no difference of parameters of ACA without LMA between two sides(P>0.05).(3)The PSV and EDV of ipsilateral ICA in LMA group were significantly higher than those in NLMA group,and RI was lower(all P<0.01).(4)The PSV,EDV of ipsilateral ACA had positive linear correlation with PSV of ipsilateral ICA(r=0.350,r=0.367,P<0.01),and had negative linear correlation with RI of ipsilateral ICA(r=-0.550,r=0.531,P<0.01).(5)The areas under ROC curve of PSVACA,EDVACA,RATIOACA for evaluating LMA were 0.978,0.947 and 0.884(all P<0.05).The cutoff value of PSVACA,EDVACA and RATIOACA were 130cm/s,60cm/s and 1.35 respectively.(6)The infarction in LMA group was less serious than that in NLMA group,lacunar infarction represented a major portion(51.0%,25/49)in LMA group,small and moderate infarction has the largest percentage of 45.0%(27/60),the number of large infarction in NLMA group was larger than that in LMA group(21.7%vs 4.1%,13/60 vs 2/49),the difference between the two groups was statistically significant(P<0.01).(7)There was a negative correlation between cerebral infarction area and PSV of MCA in NLMA group(P=-0.736,P<0.01),and cerebral infarction area was negative correlated with RATIOMCA(P =-0.849,P<0.01).Conclusion:1.The LMA can reduce severity of cerebral infarctionin patients with MCA chronic occlusion disease,and can improve the symptom to reduce the incidence of stroke.2.TCCS can be used for detecting increased velocity and decreased RI in ipsilateral ACA in MCA chronic occlusion patients with LMA.3.The PSVACA,EDVACA and RATIOACA can be used for predicting LMA,and the cutoff value was 130cm/s,60cm/s and 1.35 respectively.4.When LMA was absence,the PSV of MCA was negative with infarction area,and RATIOMCA was negative with infarction area,it can be used for indicating the outcome of patients by detecting the velocity of ipsilateral MCA.