Increased Pulsatility Index in Acute Lacunar Infarction with Type II Diabetes

J Korean Neurol Assoc > Volume 23(4); 2005 > Article

Journal of the Korean Neurological Association 2005;23(4): 457-462.

제2형 당뇨병을 동반한 급성기 열공성 뇌경색에서 박동성 지수의 증가

이기욱, 박지형 최영철 한상원a 남효석a 허지회a 이경열

연세대학교 의과대학 신경과학교실 영동세브란스병원, 신촌세브란스병원a

Increased Pulsatility Index in Acute Lacunar Infarction with Type II Diabetes

Kee Oog Lee

Department of Neurology, Yonsei University College of Medicine, Yongdong Severance Hospital, Shinchon Severance Hospitala, Seoul, Korea

Abstract

Background: The pulsatility index (PI) measured by a transcranial Doppler (TCD) has been postulated to reflect the vascular resistance that is distal to the artery being examined. Therefore, pathologies of small perforating arteries may affect the PI of the proximal artery. Microangiopathy is a common vascular complication of diabetes mellitus (DM), which may contribute to the development of small infarctions involving the perforating artery, and may be reflected on the PI.
Methods: We enrolled patients with acute cerebral infarctions who were examined by TCD, MRI, and MRA and fulfilled the following criteria: 1)an infarction of less than 2 cm size involving a single perforating arterial territory; 2)no significant arterial stenosis on MRA; and 3)no cardioembolic sources. Patients were divided into either a group with DM, or without and TCD findings were compared.
Results: The DM group showed higher PI than non-DM (0.99 v.s. 0.85 for the right middle cerebral artery; 1.02 v.s. 0.85 for the left middle cerebral artery; and 0.94 v.s. 0.78 for the basilar artery). The mean flow velocity was comparable between the groups. Multivariate linear regression analysis revealed that the duration of DM was a significant predictor of elevated PI of the bilateral MCA and basilar artery and that age was another significant predictor in the case of basilar artery.
Conclusions: The elevated PIs in DM patients suggest the possible role of diabetic microvascular complications in the development of the lacunar infarction. The PI measurement using TCD may be a useful marker of the lacunar infarction, especially in DM patients.KeyWords:Transcranial Doppler, Pulsatility index, Lacunar infarction, Diabetes mellitus