Increased pulsatility of the intracranial blood flow spectral waveform on transcranial doppler does not point to peripheral arterial disease in stroke patients

Kristian Barlinn, Stanislava Kolieskova, Reza Bavarsad Shahripour, Jessica Kepplinger, Amelia K. Boehme, Timo Siepmann, Volker Puetz, Ulf Bodechtel, William D. Jordan, Andrei Alexandrov

Research output: Contribution to journalArticle

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Abstract

Background Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. Methods We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to.75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to.9 or more was considered predictive of definite PAD. Results We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P =.60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR],.68; 95% CI,.22-2.12; P =.51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P =.002 and OR, 3.20; 95% CI, 1.51-6.77; P =.002, respectively). Conclusions Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.

Original languageEnglish (US)
Pages (from-to)189-195
Number of pages7
JournalJournal of Stroke and Cerebrovascular Diseases
Volume24
Issue number1
DOIs
StatePublished - Jan 1 2015

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Peripheral Arterial Disease
Stroke
Brain Ischemia
Ankle Brachial Index
Confidence Intervals
Odds Ratio
Intracranial Arterial Diseases
Hypertension
Basilar Artery
Middle Cerebral Artery
National Institutes of Health (U.S.)

All Science Journal Classification (ASJC) codes

  • Surgery
  • Rehabilitation
  • Clinical Neurology
  • Cardiology and Cardiovascular Medicine

Cite this

Increased pulsatility of the intracranial blood flow spectral waveform on transcranial doppler does not point to peripheral arterial disease in stroke patients. / Barlinn, Kristian; Kolieskova, Stanislava; Bavarsad Shahripour, Reza; Kepplinger, Jessica; Boehme, Amelia K.; Siepmann, Timo; Puetz, Volker; Bodechtel, Ulf; Jordan, William D.; Alexandrov, Andrei.

In: Journal of Stroke and Cerebrovascular Diseases, Vol. 24, No. 1, 01.01.2015, p. 189-195.

Research output: Contribution to journalArticle

Barlinn, Kristian ; Kolieskova, Stanislava ; Bavarsad Shahripour, Reza ; Kepplinger, Jessica ; Boehme, Amelia K. ; Siepmann, Timo ; Puetz, Volker ; Bodechtel, Ulf ; Jordan, William D. ; Alexandrov, Andrei. / Increased pulsatility of the intracranial blood flow spectral waveform on transcranial doppler does not point to peripheral arterial disease in stroke patients. In: Journal of Stroke and Cerebrovascular Diseases. 2015 ; Vol. 24, No. 1. pp. 189-195.
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abstract = "Background Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. Methods We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to.75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to.9 or more was considered predictive of definite PAD. Results We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3{\%}; 95{\%} confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8{\%} vs. 28.2{\%}, P =.60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2{\%} vs. 5.6{\%}, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR],.68; 95{\%} CI,.22-2.12; P =.51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95{\%} CI, 1.19-2.21; P =.002 and OR, 3.20; 95{\%} CI, 1.51-6.77; P =.002, respectively). Conclusions Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.",
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T1 - Increased pulsatility of the intracranial blood flow spectral waveform on transcranial doppler does not point to peripheral arterial disease in stroke patients

AU - Barlinn, Kristian

AU - Kolieskova, Stanislava

AU - Bavarsad Shahripour, Reza

AU - Kepplinger, Jessica

AU - Boehme, Amelia K.

AU - Siepmann, Timo

AU - Puetz, Volker

AU - Bodechtel, Ulf

AU - Jordan, William D.

AU - Alexandrov, Andrei

PY - 2015/1/1

Y1 - 2015/1/1

N2 - Background Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. Methods We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to.75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to.9 or more was considered predictive of definite PAD. Results We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P =.60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR],.68; 95% CI,.22-2.12; P =.51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P =.002 and OR, 3.20; 95% CI, 1.51-6.77; P =.002, respectively). Conclusions Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.

AB - Background Peripheral arterial disease (PAD) is common in patients with acute cerebral ischemia. Indexes of resistance derived from the systolic and diastolic velocities are routinely used in diagnostic transcranial Doppler (TCD) to detect intracranial arterial disease. We sought to explore whether these indexes can predict the presence of PAD in acute cerebral ischemia. Methods We prospectively evaluated consecutive patients with acute cerebral ischemia. On TCD, peak-systolic and end-diastolic velocities in both middle cerebral and basilar arteries were manually measured to calculate pulsatility index (PI) and resistance index (RI). Increased resistance was defined as PI equal to 1.2 or more and RI equal to.75 or more. Ankle-brachial index (ABI) measurements were performed and an ABI equal to.9 or more was considered predictive of definite PAD. Results We included 95 patients (45 male, 50 female) aged 66 ± 9 years with a median National Institutes Health Stroke Scale score of 3 (interquartile range, 8) points. The ABI was abnormal and consistent with definite PAD in 24 of 95 (25.3%; 95% confidence interval [CI], 16.4-34.2) patients. Increased PI did not differ among patients with and without PAD (20.8% vs. 28.2%, P =.60). Only 1 patient with PAD had increased RI as opposed to 4 patients without PAD (4.2% vs. 5.6%, P = 1.0). Increased PI was not found to be an independent predictor of PAD (odds ratio [OR],.68; 95% CI,.22-2.12; P =.51). Increases in both PI and RI independently predicted arterial hypertension (OR, 1.62; 95% CI, 1.19-2.21; P =.002 and OR, 3.20; 95% CI, 1.51-6.77; P =.002, respectively). Conclusions Our findings indicate that PAD cannot be inferred from intracranial flow parameters predictive of arterial disease and risk factors such as hypertension among patients with acute cerebral ischemia.

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