Homocysteine and pulsatility index of cerebral arteries
Mi-Hye Lim1, Young I Cho, Seul-Ki Jeong
1Department of Neurology, Chonbuk National University Medical School and Hospital, Jeonju, Jeonbuk, Korea.
Insights
Plasma total homocysteine (tHcy) is linked to higher cerebral arterial resistance in ischemic stroke patients without carotid steno-occlusion. This association is obscured when hemodynamics are altered, such as in patients with internal carotid steno-occlusion.
Area of Science:
- Neuroscience
- Vascular Biology
- Biochemistry
Background:
- Pulsatility index (PI) quantifies distal vascular resistance.
- Elevated plasma total homocysteine (tHcy) is a risk factor for cardiovascular and cerebrovascular diseases.
- Cerebral arterial hemodynamics are crucial in ischemic stroke pathophysiology.
Purpose of the Study:
- To investigate the association between plasma total homocysteine (tHcy) levels and pulsatility indices (PIs) in cerebral arteries of ischemic stroke patients.
- To determine if internal carotid arterial steno-occlusion (ICS) influences the relationship between tHcy and cerebral arterial resistance.
Main Methods:
- Transcranial Doppler ultrasound was used to measure PIs in middle cerebral, vertebral, and basilar arteries of ischemic stroke patients.
- Patients were categorized into groups with and without proximal internal carotid arterial steno-occlusion (ICS).
- Plasma tHcy levels were measured and analyzed for association with PIs, adjusting for potential confounders.
Main Results:
- In ischemic stroke patients without ICS (n=272), plasma tHcy was independently associated with increased PIs in all examined cerebral arteries.
- In contrast, no significant association between tHcy and PI was observed in patients with ICS (n=92).
- Despite elevated mean flow velocities in vertebral and basilar arteries in the ICS group, PIs did not differ significantly between groups.
Conclusions:
- Plasma tHcy is directly associated with increased resistance in cerebral arteries.
- The impact of tHcy on cerebral arterial resistance may be masked or altered in the presence of significant hemodynamic changes, such as those caused by internal carotid arterial steno-occlusion.
Background And Purpose:
A pulsatility index (PI) represents vascular resistance distal to an examined artery. The purpose of the present study was to evaluate an association between plasma total homocysteine (tHcy) and PIs of the cerebral arteries in patients with ischemic stroke.
Methods:
Consecutive patients with ischemic stroke referred to a neurovascular ultrasound laboratory were evaluated from March 2007 to February 2008. PI was defined as (peak systolic velocity-end-diastolic velocity)/mean flow velocity as recommended. Transcranial Doppler was examined in both middle cerebral arteries and vertebral arteries, and basilar arteries. All patients with ischemic stroke were subdivided according to the presence of proximal internal carotid arterial steno-occlusion (ICS).
Results:
The numbers of patients enrolled for the present analysis as ischemic stroke without and with ICS were 272 and 92, respectively. PIs measured in the cerebral arteries did not show a significant difference in the two groups, in spite of the fact that mean flow velocities of both basilar arteries and vertebral arteries were significantly elevated in the patients with ICS. Plasma tHcy was found to be independently associated with graded increases of PIs in all cerebral arteries in the patients without ICS, even adjusted for the potential confounders. However, there was no association between tHcy and PI in the patients with ICS.
Conclusion:
Plasma tHcy was directly associated with increased cerebral arterial resistance. But in clinical situations when the cerebral arterial hemodynamics were altered as in the patients with ICS, the effect of tHcy on arterial remodeling could be obscured.
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