engleski

STROKE PATTERNS AND BREATH HOLDING INDEX IN PATIENTS WITH SYMPTOMATIC HIGH GRADE CAROTID STENOSIS

Background: The aim of the study was to evaluate correlation of stroke patterns and breath holding index in patients with symptomatic high grade carotid stenosis. Breath holding index (BHI) reflects the functional state of intracranial hemodynamics, previous studies have shown that there is statisticaly significant difference between patients with different number and pattern of intracranial collateral pathways. Methods: We evaluated data from 121 patients with high grade carotid stenosis (definition according to standardized criteria of Cerebrovascular laboratory-Referral Center for Neurovascular Disorders Ministry of Health Republic of Croatia). All patients underwent CDFI, TCD and CT/MR imaging tests, complete laboratory workup, ECG, chest X-ray and spinal tap in selected cases. CDFI and TCD findings were done in standardized manner. Breath holding index was calculated as percentage increase in MBFV occurring during breath holding divided by the time (seconds) for which the subject hold his/her breath. All patients had verified recent ischemia of brain parenchyma on CT/MR scan. Results: There were 38 (45%) patients (mean age 71± 10) with first ever stroke-17 (32%) men (mean age 66± 12) and 21 (66%) women (mean age 74± 10) , they mostly activated one collateral pathway (33 patients-87%)-anterior or posterior one ; while patients with reccurent stroke-48 (55%) patients ; 37(68%) men and 11 (34%) women activated two or more collateral pathways (44 patients-91%)-anterior and posterior collateral pathway in adition with ophtalmic artery collateral pathway or cortical collaterals. According to blood supply teritories 26 (29%) patients-17 (20%) men and 9 (11%) women had recent ischemic lesion in the teritorry of anterior cerebral artery (ACA) ipsilaterally to the side of stenosis ; BHI=± , there were 47 (54%) patients- 30 men (35%) and 17 women (20%) who had ischemic lesion in the teritorry of middle cerebral artery (MCA) ipsilaterally to the side of stenosis ; BHI=0, 52± 0, 16, there were 8 (10%) patients- 4 men (5%) and 3 women (3%) who had ischemic lesion in the supply teritorry of posterior cerebral artery (PCA) ipsilaterally to the side of stenosis ; BHI=0, 35± 10, only 6 (7%) of patients- 3 men (3%) and 3 women (3%) had ischemic lesion contalaterally to the side of stenosis ; BHI=0, 13± 0, 11. Conclusion: In patients with unilateral high grade symptomatic carotid artery stenosis stroke patterns usually can be visualised in blood supply teritories of main basal cerebral arteries according to activation and exhaustion of intracranial collateral pathways.

breath holding Index; transcranial doppler; stroke; carotid stenosis

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