Background: Intracranial atherosclerotic disease (IAD) is a known risk factor for incident and recurrent stroke. Changes in blood flow velocity within diseased vessels over time have not been well characterized. We sought to evaluate the natural progression of TCD velocities in patients with intracranial stenosis.Design/Methods: We queried a hospital-based stroke registry database for all subjects who had at least two transcranial Dopplers (TCDs). Inclusion criteria were peak systolic velocities 蠅 200 cm/s in the anterior circulation and 蠅 150 cm/s in the posterior circulation, confirmation of stenosis by an auxiliary test, and serial TCDs at least one week apart. We excluded subjects with evidence of subarachnoid hemorrhage. A change in mean velocity of 20% or more was considered clinically relevant.Results: Fifty-seven patients were included (mean age 65 ± 11, 41% women), with 91 vessels meeting at least one elevated velocity inclusion criterion; 2/3 had more than one follow-up TCD. Average time to first follow-up was 4.6 months (range 14 days-62 months), while average time to final followup was 31.5 months (18 days-102 months). Most vessels showed stable (n=41) or decreased (n=32) velocities at final followup. Patients with increased velocities (26%) at final follow up were more likely female (67% vs 29%, p=0.015) and older (71 vs 63 years, p=0.036). Patients with increased TCD velocities had a longer mean follow-up time (55.6 months vs 23.4 months, p<0.001).Conclusions: Serial TCDs for most patients with IAD receiving the standard of care show stable or decreased cerebral flow velocities over time; only a quarter of patients (20% of vessels) had increased velocities suggestive of progression of IAD. In our series, older women were at increased risk of progression. Further investigation of our findings is needed to evaluate the clinical implications of these observations.
Disclosure: Dr. Cutting has received personal compensation for activities with F1000. Dr. Rundek has nothing to disclose. Dr. Del Brutto has nothing to disclose. Dr. Koch has nothing to disclose. Dr. Sacco has nothing to disclose. Dr. Romano has received personal compensation for activities with NovaVision. Dr. Romano has received research support from NovaVision.
Original Article: http://www.neurology.org/cgi/content/short/82/10_Supplement/P1.150?rss=1
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