Investigation of Carotid Stenosis and Blood Flow in Patients with Middle Cerebral Artery Thrombosis and Embolism by Duplex Ultrasonography

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We used duplex ultrasonography to evaluate extracranial carotid artery lesion and common carotid blood flow in 249 patients with ischemic cerebrovascular disease. The equipment used was the EUB-415 (Hitachi Medico) with a 7.5 MHz linear type probe with an attached 20°coupler. We investigated the relation between carotid artery stenosis (%Stenosis) and end-diastolic flow velocity (%Dec-Ved) . We also investigated the possibility of differentiating embolic middle cerebral artery (MCA) occlusion from thrombotic MCA occlusion using these two parameters.<BR>In order to investigate the relationship between %Stenosis and %Dec-Ved in all the patients studied with and without carotid stenosis, a two-dimensional graph was prepared for each patient plotting %Stenosis on the abscissa and %Dec-Ved on the ordinate. The patients studied were classified into four groups by drawing a line at the 80% carotid stenotic point and another line at the 30% reduction point in the end-diastolic flow velocity. The critical point of reduction in the %Dec-Ved was 80% stenosis of the carotid artery, and the critical point differentiating embolism from thrombosis was 30% decrease in %Dec-Ved. The incidence of carotid atherosclerotic lesions among the patients with cardiogenic cerebral embolism was much lower than that among those with cerebral thrombosis. The end-diastolic flow velocity in the affected common carotid artery was significantly decreased in embolic MCA occlusion, but was not decreased in thrombotic MCA occlusion.<BR>In conclusion, we suspect that ultrasonographic classification of patients with ischemic strokes on the basis of %Dec-Ved and %Stenosis is useful in differentiating acute embolic MCA occlusion from thrombotic MCA occlusion and locating the site of vessel occlusion.
日本脳神経超音波学会の論文

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