The Effect of Pulsatility Index on Infarct Volume in Acute Lacunar Stroke

Abstract

PurposeLacunar stroke, in the context of small vessel disease, is a type of cerebral infarction caused by occlusion of a penetrating artery. Pulsatility index (PI) is an easily measurable parameter in Transcranial Doppler ultrasound (TCD) study. PI reflects distal cerebral vascular resistance and has been interpreted as a surrogate marker of small vessel disease. We hypothesized that an increased PI, a marker of small vessel disease, might be associated with a larger infarct volume in acute lacunar stroke.Materials and MethodsThis study included 64 patients with acute lacunar stroke who underwent TCD and brain MRI. We evaluated the association between the mean PI value of bilateral middle cerebral arteries and infarct volume on diffusion-weighted MRI using univariate and multivariate linear regression.ResultsThe mean infarct volume and PI were 482.18±406.40 mm3 and 0.86±0.18, respectively. On univariate linear regression, there was a significant positive association between PI and infarct volume (p=0.001). In the multivariate model, a single standard deviation increase of PI (per 0.18) was associated with an increase of 139.05 mm3 in infarct volume (95% confidence interval, 21.25 to 256.85; p=0.022).ConclusionWe demonstrated that PI was an independent determinant of infarct volume in acute lacunar stroke. The PI value measured in acute stroke may be a surrogate marker of the extent of ischemic injury.

Impact of Asymmetric Middle Cerebral Artery Velocity on Functional Recovery in Patients with Transient Ischemic Attack or Acute Ischemic Stroke

“…In this study, we found that a higher MCA asymmetry [6,7]. Concerning the relationship between TCD parameters and prognosis, MFV and PI were independent prognostic factors for recurrent vascular events in patients with transient ischemic attack or minor ischemic stroke [4] and also useful to predict short-term functional outcome in stroke patients with recanalization after intravenous thrombolysis [17].…”

“…Other researchers have reported that an elevated PI is associated with cerebrospinal fluid pressure, cognitive performance, and infarct volume in patients with lacunar infarcts [5][6][7]. However, there is relatively little information on the laterality of each parameter, which includes the association between the lateral difference and some disorders such as cluster headache and acute intracerebral hemorrhage [8,9].…”

Microbleeds of Lacunar Infarction and Middle Cerebral Artery Flow Velocity of Branch Atheromatous Disease Are Essential Factors of Stroke Etiology

“…This appears to indicate that small atheromatous plaques of the MCA major trunk cause slight stenosis in the larger size group. Kim et al [6] reported that there was a significant positive association between the PI measured by transcranial Doppler (TCD) and infarct volume in acute lacunar stroke. In the present study, infarction size was not significantly associated with PI, but it was associated with PSV of M1.…”

“…Neurological deterioration and worse prognosis have been reported and are considered to be Terasawa related to enlargement of infarct volume [5]. Some factors such as the serum cholesterol level [5] and the pulsatility index (PI) of the middle cerebral artery (MCA) [6] are reported to be associated with increased infarct size. However, there are no strong factors that are commonly recognized to be associated with larger size of infarct.…”

Prediction of functional outcome using the novel asymmetric middle cerebral artery index in cryptogenic stroke patients

“…Many TCD-based studies in stroke patients have been conducted using MV and PI. Increased MV was closely related to severe stenosis of relevant intracranial cerebral arteries, and increased PI was associated with small artery disease in diabetes patients and a larger infarction in lacunar stroke [6, 16, 17]. In addition, PI could play a role in estimating intracranial pressure [18].…”