Middle Cerebral Artery In Patients Research Articles

Association of vulnerable plaques with white matter hyperintensities on high-resolution magnetic resonance imaging.

One of the widespread manifestations of cerebral small vessel disease (CSVD) of the brain parenchyma is white matter lesion, which appears as white matter hyperintensities (WMHs) on magnetic resonance imaging (MRI). Previous studies have illustrated that large artery atherosclerosis is related to CSVD, but the precise progress of pathogenesis remains unknown. High-resolution MRI (HR-MRI) has the ability to delineate intracranial vascular walls, enabling a thorough exploration of the structure and composition of unstable plaques. This study aimed to apply HR-MRI to characterize the wall changes and plaque characteristics of middle cerebral arteries in patients with WMHs and to investigate the correlation between plaque vulnerability parameters and different degrees of WMHs. In this study, 138 patients with acute ischemic stroke at Harbin Medical University's First Clinical Hospital (May 2021 to October 2023) were cross-sectionally reviewed and underwent conventional brain and HR-MRI using T1-weighted 3D volumetric isotropic turbo spin echo acquisition (T1W-3D-VISTA) of the unilateral middle cerebral artery (MCA). According to Fazekas grade (0-6), the patients were divided into two groups: Fazekas score 0-2, no-or-mild WMHs; and Fazekas 3-6, moderate-to-severe WMHs. The intraplaque hemorrhage, plaque distribution, plaque enhancement, plaque load, remodeling pattern, and stenosis of the two groups were measured. Binary logistic regression analysis was conducted to evaluate the relationship between vulnerable plaques and WMHs. Of the participants who were initially considered for inclusion, 71 were deemed eligible, among whom 34 were placed in the no-or-mild WMH group and 37 in the moderate-to-severe WMH group. Between the two groups, there were significant differences in intraplaque hemorrhage (P=0.01), a wide distribution (P=0.02), and plaque enhancement (P=0.02). Univariate analysis showed that WMHs were associated with age [odds ratio (OR) =1.080; 95% confidence interval (CI): 1.020-1.144; P=0.008], hypertension (OR =3.500; 95% CI: 1.276-9.597; P=0.01), intraplaque hemorrhage (OR =3.955; 95% CI: 1.247-12.538; P=0.02), a wide distribution (OR =3.067; 95% CI: 1.159-8.115; P=0.02), and significant plaque enhancement (OR =4.372; 95% CI: 1.101-17.358; P=0.03); however, the multivariate results showed that the only independent factors associated with WMHs were age (OR =1.095; 95% CI: 1.019-1.176; P=0.01) and intraplaque hemorrhage (OR =5.88; 95% CI: 1.466-23.592; P=0.01). Our findings suggest that age and intraplaque hemorrhage may be associated with more severe WMHs in patients with acute ischemic stroke, which may be helpful for further clinical examination and intervention treatment.

Impaired dynamic cerebral autoregulation measured in the middle cerebral artery in patients with vertebrobasilar ischemia is associated with autonomic failure.

ObjectivesTo assess whether vertebrobasilar artery ischemia (VBI) affects cortical cerebral blood flow (CBF) regulation. Material and Methods107 consecutive patients (mean age 65 ± 15 years; women 21) with VBI underwent structured stroke care with assessment of dynamic cerebral autoregulation (dCA) in both middle cerebral arteries (MCAs) by transfer function analysis using spontaneous oscillations of blood pressure (BP) and CBF velocity that yields by extraction of phase and gain information in the very low (0.02-0.07 Hz), low (0.07-0.15 Hz) and high frequency (0.15-0.5 Hz) ranges. Additionally, power spectrum analysis of BP and heart rate variability (HRV) was performed. The control group consists of 29 age- and sex-matched healthy persons. ResultsCompared to controls, phase in the VBI patients was significantly reduced and gain increased in the very low frequencies (VLF), in the low (LF), phase was significantly reduced only ipsilaterally. In the high frequencies (HF), phase reduction was only marginally significant. BP power spectral density (PSD) was much higher in the patients than in the controls across all frequencies. In the PSD of heart rate variability the controls but not the patients exhibited a strong peak around 0.11Hz, while the patients, but not the controls, exhibit a strong peak around 0.36 Hz. In regression analysis, patient's phase and gain results were not related to age, sex, arterial hypertension, diabetes mellitus, renal dysfunction, heart failure as indicated by left ventricular ejection fraction, stroke subtype, presence or absence of cerebral small vessel disease. ConclusionPatients with VBI exhibit bilateral cortical autoregulation impairment in association with an autonomic nervous system disbalance. ClinicalTrials.gov IdentifierNCT04611672

Retracted: Correlation between Lpa, APO-A, APO-B, and Stenosis of Middle Cerebral Artery in Patients with Cerebral Ischemic Stroke.

[This retracts the article DOI: 10.1155/2022/6403645.].

Automatic Alberta Stroke Program Early Computed Tomographic Scoring in patients with acute ischemic stroke using diffusion-weighted imaging.

Alberta Stroke Program Early Computed Tomographic Scoring (ASPECTS) is a reliable method for assessing early ischemic changes in the blood supply area of the middle cerebral artery in patients with acute ischemic stroke. This study aims to propose a deep learning based automatic evaluation strategy for DWI-ASPECTS to serve as a reference for clinicians in urgent decision making for endovascular thrombectomy. Ten ASPECTS regions are extracted from the DWI series to train the independent classification network for each region, the accurate training labels of which are confirmed by neuroradiologists. Two classical convolutional neural networks (VGG-16 and ResNet-50) are validated. Subsequently, the innovative CBAM-VGG is designed to improve the accurate scoring of four small-volume DWI-ASPECTS regions, including caudate nucleus, lenticular nucleus, internal capsule, and insular lobe. Average F1-score of 0.929 and 0.840 and the average accuracy of 94.75% and 84.99% are obtained when scoring on six cortical regions M1-M6 and four small ASPECTS regions, respectively. In addition, the modified algorithm CBAM-VGG shows a significant improvement in the accuracy of estimating the four ASPECTS regions with smaller volumes. The experimental results demonstrate that the deep learning methods facilitate the efficiency and robustness of automatic DWI-ASPECTS scoring, which can provide a reference for clinical decision-making.

Correlation between Lpa, APO-A, APO-B, and Stenosis of Middle Cerebral Artery in Patients with Cerebral Ischemic Stroke.

Ischemic stroke (CIS) is characterized by a high incidence, disability, and mortality. Numerous studies have demonstrated that intracranial arterial stenosis is an important pathological basis of CIS, and its main cause is atherosclerosis. Dyslipidemia is an important risk factor for atherosclerosis. Lysophosphatidic acid (Lpa), apolipoprotein -A(APO-A), and apolipoprotein -B(APO-B) proved to be significantly correlated with the severity of coronary artery disease. This study retrospectively collected the case data of 186 patients with CIS treated from May 2020 to May 2022 and explored the correlation between Lpa, APO-A, APO-B, and middle cerebral artery (MCA) stenosis in CIS patients.

Wall characteristics of atherosclerotic middle cerebral arteries in patients with single or multiple infarcts: A high-resolution MRI Study.

Understanding the stroke mechanism of middle cerebral artery (MCA) atherosclerosis may inform secondary prevention. The aim of this study was to explore the relationship between vascular wall characteristics and infarction patterns using high-resolution magnetic resonance imaging (HRMRI) and diffusion-weighted imaging (DWI). From November 2018 to March 2021, patients with acute ischemic stroke due to MCA atherosclerotic disease were retrospectively analyzed. The wall characteristics of atherosclerotic MCA, including conventional characteristics and histogram-defined characteristics, were evaluated using HRMRI. Patients were divided into single-infarction and multiple-infarction groups based on DWI, and wall characteristics were compared between the two groups. Of 92 patients with MCA plaques, 59 patients (64.1%) had multiple infarcts, and 33 (35.9%) had single infarcts. The histogram-defined characteristics showed no differences between the single-infarction and multiple-infarction groups (P>0.05). Plaque burden, degree of stenosis, and prevalence of intraplaque hemorrhage (IPH) were significantly greater in the multiple-infarction group than in the single-infarction group (plaque burden: P = 0.001; degree of stenosis: P = 0.010; IPH: P = 0.019). Multivariate analysis showed that plaque burden (odds ratio: 1.136; 95% confidence interval: 1.054-1.224, P = 0.001) and IPH (odds ratio: 5.248; 95% confidence interval: 1.573-17.512, P = 0.007) were independent predictors for multiple infarction. IPH and plaque burden are independently associated with multiple infarcts. HRMRI may provide new insight into the mechanisms underlying the different MCA infarction patterns.

Comparative Study between the Effect of Nifedipine, Ritodrine and Indomethacin Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Comparative Study between the Effect of Nifedipine, Ritodrine and Indomethacin Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Peak Systolic Velocity in Middle Cerebral Artery in Patients with Severe Traumatic Brain Injury as an Indicator of Detrimental Rise in Intracranial Pressure

Background Intracranial pressure (ICP) is the major concern for neurosurgeons while treating patients with severe traumatic brain injury, as any troublesome escalation in intracranial pressure heralds feared complications leading to definite morbidity or even mortality.
 Objective This study focuses on analyzing the correlation between peak systolic velocity in middle cerebral artery derived from transcranial doppler ultrasonographic spectral analysis and intracranial pressure values derived from invasive intracranial pressure monitoring system in a patient with severe traumatic brain injury.
 Method A prospective observational study was performed using a convenience sample technique including all adult patients with severe traumatic brain injury who had invasive intracranial monitors placed as part of their clinical care. Transcranial doppler ultrasonography was performed with a 2 MHz linear probe of ACUSON X300 ultrasound system while simultaneous intracranial pressure readings were obtained directly from invasive intracranial pressure monitoring. The association between peak systolic velocity in the middle cerebral artery and invasive intracranial pressure was assessed with Pearson’s correlation coefficient.
 Result One hundred one transcranial doppler ultrasound spectral analysis was performed on 26 individual patients. The mean age of the population involved in this study is 43.57 years ± S.D. 19.95 (range 18-78 years), with male preponderance in a ratio of 5.5:1. Pearson’s correlation coefficient of peak systolic velocity in middle cerebral artery and intracranial pressure was 0.715 (p < 0.000) demonstrating a significant positive correlation. With further evaluation of area under curve characteristics, peak systolic velocity in middle cerebral artery of 39.6 cm/s yielded the most favorable balance of test characteristics to diagnose elevation of intracranial pressure, with a resulting sensitivity of 82.1% and specificity of 84.4%.
 Conclusion Peak systolic velocity in middle cerebral artery can be explored further as a dependable screening tool to evaluate intracranial pressure among patients with severe traumatic brain injury in settings with unavailability of invasive intracranial pressure monitoring facilities.

Correlation of carbon dioxide and systolic velocity of the middle cerebral artery in patients with spontaneous subarachnoid hemorrhage of aneurysmal origin

BackgroundAneurysmal Subarachnid Hemorhage (aSAH) secondary to an aneurysm is the most common presentation of nontraumatic SAH. Worldwide, the incidence varies, affecting more frequently women with an average age of 55 years. One of its main complications is cerebral vasospasm. ObjectiveThe objective of this study was to evaluate the correlation between blood flow of the middle cerebral artery and arterial CO2 levels in patients with aSAH, comparing those who presented vasospasm in relation to those who did not. Material and methodsObservational, historical cohort study, including patients between 18 and 85 years old, diagnosed with Aneurysmal Subarachnoid Hemorrhage (aSAH) secondary to an aneurysm (aSAH) Spearman/Pearson correlation coefficient was used to determine the correlation between mean velocity flow (MVF) by transcranial doppler and levels CO2 serum according to the analysis group (with or without vasospasm). A value <0.05 was determined for statistical significance. ResultsBetween 2015 and 2019 a total of 54 patients diagnosed with aSAH were treated in our institution, our results indicate a positive correlation between the SVRMCA and SVLMCA with the presence of vasospasm (p value = <0.001). No correlation was observed between serum CO2 levels and SVRMCA or SVLMCA, irrespective of the presence of vasospasm. ConclusionIn patients with aneurysmal subarachnoid hemorrhage, serum CO2 levels do not correlate with cerebral systolic velocities. Further studies are required to confirm this finding.

Transcriptome-wide analysis of intracranial artery in patients with moyamoya disease showing upregulation of immune response, and downregulation of oxidative phosphorylation and DNA repair.

Moyamoya disease (MMD) is a rare cerebrovascular disease characterized by progressive occlusion of the internal carotid artery and the secondary formation of collateral vessels. Patients with MMD have ischemic attacks or intracranial bleeding, but the disease pathophysiology remains unknown. In this study, the authors aimed to identify a gene expression profile specific to the intracranial artery in MMD. This was a single-center, prospectively sampled, retrospective cohort study. Microsamples of the middle cerebral artery (MCA) were collected from patients with MMD (n = 11) and from control patients (n = 9). Using microarray techniques, transcriptome-wide analysis was performed. Comparison of MCA gene expression between patients with MMD and control patients detected 62 and 26 genes whose expression was significantly (p < 0.001 and fold change > 2) up- or downregulated, respectively, in the MCA of MMD. Gene set enrichment analysis of genes expressed in the MCA of patients with MMD revealed positive correlations with genes involved in antigen processing and presentation, the dendritic cell pathway, cytokine pathway, and interleukin-12 pathway, and negative correlations with genes involved in oxidative phosphorylation and DNA repair. Microarray analysis was validated by quantitative polymerase chain reaction. Transcriptome-wide analysis showed upregulation of genes for immune responses and downregulation of genes for DNA repair and oxidative phosphorylation within the intracranial artery of patients with MMD. These findings may represent clues to the pathophysiology of MMD.

An automated ASPECTS method with atlas-based segmentation

Background and PurposeAs a simple and reliable systematic method to evaluate the early ischemic changes in the blood supply region of the middle cerebral artery of patients with ischemic stroke, the Alberta Stroke Program Early CT score (ASPECTS) can be used for rapid semi-quantitative evaluation of ischemic lesions, which is helpful to select potential candidates for intravenous and intra-arterial therapies, determine the thrombolytic effect and long-term prognosis. This method mainly relies on doctors’ visual observation. However, due to different levels of doctor's experience, the poor inter-reader agreement may result in errors in the final ASPECTS. The purpose of this work was to propose an automated semi-quantitative method for the diagnosis of acute ischemic stroke based on non-contrast computed tomography (NCCT), to provide a reference for doctors in the diagnosis and evaluation. MethodsNCCT data from a total of 90 patients were included for auto-ASPECTS training and testing. After preprocessing CT images, the regions of interest (ROI) for ASPECTS were labeled using atlas-based segmentation. The mean difference, mean ratio and brain density shifts (BDS) of the corresponding regions of the contralateral brain were used as the standard for quantitative analysis. The auto-ASPECTS method was developed and validated to predict early ischemic changes whose performance was evaluated by the agreement (accuracy) of predictions and consensus scores of two observers. ResultsA comparison was made among the results on mean difference, mean ratio, BDS and the combination of multiple parameters as the standard. The result of using BDS alone was relatively better than the result of using any other parameter alone or any combination of multiple parameters, and accuracy in the test set was 0.80. In the test set, accuracy with using different BDS thresholds increased by 6.67% compared with using the consistent BDS threshold. After dichotomy of auto-ASPECTS and consensus scores with the threshold of 7, the agreement of them was 83.3% and there was no significant difference between the two distributions (p = 0.344) in McNemar test. ConclusionsThe proposed auto-ASPECTS method for NCCT images can provide useful information for early diagnosis and evaluation of patients with acute ischemic stroke (AIS).

Clinical Study of Endovascular Treatment of Severe Middle Cerebral Artery Stenosis or Occlusion and Vascular Cognitive Impairment

Objective: It is very important to study the factors affecting the incidence, progress and prognosis of patients with vascular dementia. Methods: 50 cases of severe middle cerebral artery stenosis or occlusion underwent endovascular treatment (25 cases of mild cognitive dysfunction, 25 cases of moderate cognitive dysfunction) were divided into two groups, where a medical drug treatment group and a control group established with 25 cases in each group. The cognitive function of each group of patients was evaluated before operation, 7 days after operation, 30 days after operation, and 180 days after operation. CTP was used to compare the hemodynamic changes in patients before and after operation. Results: The severe stenosis or occlusion of the middle cerebral artery in patients can be improved, and the intracranial blood supply of patients with poorly compensated medial cranial circulation and hypoperfusion can be restored to a certain extent. Meanwhile, improvement of cognitive function was definitive in some patients with cognitive dysfunction. Conclusion: To guide the formulation of treatment plans for patients with severe middle cerebral artery stenosis or occlusion.

Morphometric study of the bilateral middle cerebral arteries in patients with a unilateral aneurysm

Morphometric study of the bilateral middle cerebral arteries in patients with a unilateral aneurysm

Transcriptomic Profile of Distal Middle Cerebral Artery from Moyamoya Disease Patients Reveals a Potential Unique Pathway

BACKGROUND: Moyamoya disease (MMD) is a peculiar disease, characterized by progressive steno-occlusion of the distal ends of bilateral internal carotid arteries and their proximal branches. Numerous studies of MMD investigated as a singular pathway, thus overlooked the complexity of MMD pathobiology.&#x0D; AIM: In this study, we sought to investigate the gene expression in the involved arteries to reveal the novel mechanism of MMD.&#x0D; MATERIALS AND METHODS: Eight middle cerebral artery (MCA) specimens were obtained from six patients underwent surgical procedure superficial temporal artery to MCA (STA-MCA bypass) for MMD and two control patients. We performed RNA extraction and microarray analysis with Agilent Whole Human Genome DNA microarray 4x44K ver.2.0 (Agilent Tech., Inc., Wilmington, DE, USA).&#x0D; RESULTS: From 42,405 gene probes assayed, 921 gene probes were differentially regulated in MCA of patients with MMD. Subsequent pathway analysis with PANTHER database revealed that angiogenesis, inflammation, integrin, platelet-derived growth factor (PDGF), and WNT pathways were distinctly regulated in MMD. Among genes in aforementioned pathways, SOS1 and AKT2 were the mostly distinctly regulated genes and closely associated with RAS pathway.&#x0D; CONCLUSION: The gene expression in MCA of patients with MMD was distinctly regulated in comparison with control MCA; presumably be useful for elucidating MMD pathobiology.

Impaired Dynamic Cerebral Autoregulation in Cerebral Venous Thrombosis.

Background: Cerebral autoregulation is crucial in traumatic brain injury, which might be used for determining the optimal intracranial pressure. Cerebral venous thrombosis (CVT) is a cerebral vascular disease with features of high intracranial pressure. However, the autoregulatory mechanism of CVT remains unknown. We aimed to investigate the capacity of cerebral autoregulation in patients with CVT.Methods: This study consecutively enrolled 23 patients with CVT and 16 controls from December 2018 to May 2019. Cerebral autoregulation was assessed by transfer function analysis (rate of recovery/phase/gain) using the spontaneous oscillations of the cerebral blood flow velocity and arterial blood pressure.Results: In total, 76 middle cerebral arteries (MCAs) were investigated, including 44 MCAs in patients with CVT and 32 normal ones. The phase shift estimated in patients with CVT was significantly different from that of the controls (37.37 ± 36.53 vs. 54.00 ± 26.78, p = 0.03). The rate of recovery and gain in patients with CVT were lower than those in controls but without statistical significance.Conclusion: To our knowledge, this is the first time that a study has indicated that patients with CVT were more likely to have impaired cerebral autoregulation. Hence, cautious blood pressure control is required in such patients to prevent hyper- or hypoperfusion.

ЦЕРЕБРАЛЬНАЯ МИКРОЭМБОЛИЯ У ПАЦИЕНТОВ С ЗАБОЛЕВНИЯМИ СЕРДЕЧНО-СОСУДИСТОЙ СИСТЕМЫ, НАХОДЯЩИХСЯ НА РЕАБИЛИТАЦИИ ПОСЛЕ НАРУШЕНИЯ МОЗГОВОГО КРОВООБРАЩЕНИЯ, ТЯЖЕЛЫХ ПОВРЕЖДЕНИЙ ГОЛОВНОГО МОЗГА

В статье приведен анализ результатов исследования частоты выявления микроэмболии в средних мозговых артериях у пациентов с заболеваниями сердечно-сосудистой системы: стенозирующими атеросклерозом церебральных артерий, фибрилляцией предсердий, проходящих лечение и реабилитацию после нарушения мозгового кровообращения, тяжёлых повреждений головного мозга вследствие сосудистых заболеваний (аневризма сосудов головного мозга, ишемический и геморрагический инсульт), черепно-мозговой травмы, опухолей головного мозга, в том числе, после нейрохирургических вмешательств в сравнении с практически здоровыми людьми.Всем обследованным был выполнен транскраниальный допплерографический мониторинг интракраниальных артерий. Детекция микроэмболов осуществлялась в ходе двухстороннего транскраниального допплеровского мониторирования потоков в средних мозговых артериях. К патологическим относили высокоэнергетические сигналы с относительным повышением мощности более 20 dB/ms, во время которых допплеровская мощность возрастала как минимум на 5 dB и длилась не менее 4 ms. Для оценки ультразвуковых характеристик атеросклеротических бляшек с помощью дуплексного сканирования у пациентов со стенозирующим атеросклерозом брахиоцефальных артерий использовали классификацию Gray-Weale А.С с соавт. Выявление и оценка атеросклеротических бляшек осуществлялась в ходе плановых исследований магистральных артерий головы линейным датчиком ультразвукового прибора DC-8, Mindray.В ходе исследования признаки микроэмболии были зарегистрированы во всех отобранных группах. Реже всего они выявлялись в контрольной группе у практически здоровых лиц, что объясняется отсутствием явных предпосылок к образованию микроэмболов. В группе пациентов с постоянной формой фибрилляцией предсердий количество случаев выявления микроэмболии не превысила половины обследованных. В группах сравнения у пациентов со стенозирующим атеросклерозом отмечается наибольшая частота выявления микроэмболии у пациентов с гетерогенными атеросклеротическими бляшками. И это совпадает с распределением среднего количества микроэмболических сигналов.

Efficacy and safety of mechanical thrombectomy for M2 segment of middle cerebral artery: a systematic review and meta-analysis.

The efficacy and safety of mechanical thrombectomy (MT) for M2 segment occlusion of middle cerebral artery in patients with acute ischemic stroke (AIS) was investigated. We searched PubMed and EMBASE from inception to 16 April 2019 for relevant studies, calculated the pool relative risks (RRs) of 3-month functional independence (modified Rankin scale score 0-2), death and symptomatic intracerebral hemorrhage (sICH) in MT for M2 segment occlusion in patients with AIS versus those of M1 segment or best medical care. Nine studies enrolling 2152 patients compared MT for patients with AIS of M2 segment occlusion and those of M1 segment occlusion. MT for M2 occlusion had a higher rate of 3-month functional independence compared to the patients with M1 occlusion. (RR 1.27, 95% CI 1.11-1.44, P < 0.001) and decreased death (RR 0.74; 95% CI 0.58-0.96, P = 0.022) with similar risk of sICH (RR 1.11; 95% CI 0.65-1.87, P = 0.707). Four studies enrolling 1016 patients compared MT and best medical care for patients with AIS of M2 occlusion. MT for M2 occlusion benefit more than best medical care on 3-month functional independence (RR 1.43, 95% CI 1.08-1.90, P = 0.011) and death (RR 0.46; 95% CI 0.22-0.96, P = 0.022) with similar risk of sICH (RR 1.65; 95% CI 0.66-4.13; P = 0.286). MT for M2 segment benefit patients with AIS on 3-month functional independence compared with that of M1 segment or medical care, without increasing the risk of sICH.

Abstract WP172: Using a Novel and Noninvasive Cerebral Augmentation Index as Evaluated by External Counterpulsation to Predict Long-term Clinical Outcome After Acute Ischemic Stroke

Background and Objectives: External counterpulsation (ECP) is a non-invasive method used to augment cerebral blood flow of patients with ischaemic stroke via induced hypertension. We aimed to investigate whether the cerebral augmentation index (CAI) evaluated by ECP can predict clinical outcomes after acute ischemic stroke. Methods: We enrolled acute ischemic stroke patients within 7 days after stroke onset. Bilateral middle cerebral arteries of patients were monitored using transcranial Doppler (TCD). Flow velocity changes before, during and after ECP were, respectively, recorded for 3 mins. The cerebral augmentation index (CAI) was the increase in percentage of the middle cerebral artery mean flow velocity during ECP compared with baseline. TCD data were analysed based on the side ipsilateral or contralateral to the infarct. The modified Rankin Scale (mRS) (good outcome: mRS 0∼2; poor outcome: mRS 3∼6) was evaluated 3 months after the index stroke. Results: 200 patients were included (mean age, 64.5±8.9 years; 86.5% males). At month 3 after stroke onset, univariate analysis showed that the National Institutes of Health Stroke Scale at recruitment was significantly higher in the poor outcome group, while the bilateral CAIs were significantly lower in the good outcome group than those in the poor outcome group (ipsilateral 3.72±2.94 vs 7.92±6.25, p=0.032; contralateral 4.04±3.82 vs 6.98±6.05, p=0.048). Multivariate logistic regression showed that bilateral CAIs were independently correlated with an unfavorable functional outcome after adjusting for confounding factors. Conclusions: The higher degree of cerebral blood flow velocity augmentation on the both sides ipsilateral and contralateral to the infarct induced by ECP is independently correlated with an unfavorable functional outcome after acute ischemic stroke.

Comparative Study between the Effect of Nifedipine, Ritodrine and Magnesium Sulphate Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Comparative Study between the Effect of Nifedipine, Ritodrine and Magnesium Sulphate Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Comparative Study between the Effect of Nifedipine, Ritodrine and Magnesium Sulphate Therapy on Doppler Indices of Fetal Umbilical and Middle Cerebral Arteries in Patients with Preterm Labour

Background: Spontaneous preterm labor (SPTL) and preterm birth (PTB), is the single most important cause of perinatal mortality and morbidity in high-income countries despite the enormous efforts over the past several decades. Preterm labor is defined as regular, painful, frequent uterine contractions causing a progressive effacement and dilatation of the cervix occurring before 37 completed weeks of gestation. Many drug therapies were used as tocolytics in cases of preterm labor, however none of them proved to be the best. The present study was performed to compare three of the used drugs for tocolysis to assess their efficacy and side effects on the mother and fetus. Aim: The aim of this study is to compare the effect of oral nifedipine, intravenous ritodrine infusion and magnesium sulfate infusion used as tocolytics in cases of preterm labour on Doppler parameters of fetal umbilical and middle cerebral artery and to evaluate their effects on the mother and the fetus in order to choose the safest and the most effective drug. Methodology: This study was held in the period from December 2014 to october 2015 on 90 patients attended and admitted from the Casualty Unit of the Obstetric Department In Elsayed Glal University Hospital with preterm labor pains , intact membranes, singleton pregnancy between 28 and completed 34 weeks gestation. All patients had been dated accurately with a gestational age based on the last menstrual period and if available a corresponding second trimester ultrasound report performed before 20 weeks gestation. Treatment continued until contractions stopped for 24 hours, maximum doses were attained without response; unacceptable side effects occurred or labor proceeded. Successful treatment was defined as cessation of contractions observed for 24 hours and no further cervical changes. Patients with successful treatment were put under observation for another 24 hours without additional treatment then discharged on no maintenance therapy. Results: Maternal tachycardia, palpitation and dyspnea were more common in the ritodrine group with (p-value = 0.000). The present study showed increase in umbilical artery PI after treatment in the magnesium sulfate group only which was statistically significant (P value = 0.016). The study showed statistically significant increase in middle cerebral artery PI after treatment in magnesium sulfate group with a P value=0.000 and statistically significant decrease in middle cerebral artery with nifedipine group with P value=0.027. When comparing the cerebroplacental ratio before and after treatment in the three groups; the study showed significant increase in cerebroplacental ratio after treatment in the magnesium sulfate group with P value = 0.000, which is statistically significant. This suggests that nifedipine could be used as a safer alternative to ritodrine and magnesium sulfate. Conclusion: In our study, nifedipine therapy was not associated with a significant change in maternal systolic and diastolic blood pressure after 24h, with minor insignificant effect on maternal heart rate. Fetal heart rate was not affected after therapy. Fetal Doppler study found no clinically significant effect on the pulsatility index (PI) of umbilical and middle cerebral artery, while with magnesium sulfate therapy there was increase in cerebro- placental ratio 24hr after treatment, these findings ensure safety of the drugs on the maternal and fetal aspects.