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Transcranial color Doppler in stroke-free adult patients with sickle cell disease
G Graziadei1, F M Casoni2, F Annoni2
1U.O. Medicina Interna, Fondazione IRCCS Ca Granda Ospedale Maggiore Policlinico, Via Francesco Sforza, 35, 20122, Milan, Italy. giovanna.graziadei@policlinico.mi.it.
Insights
Transcranial Doppler (TCD) shows higher blood flow velocities in adults with sickle cell disease (SCD). These findings may help detect abnormal cerebral blood flow and prevent strokes in SCD patients.
Area of Science:
- Neurology
- Hematology
- Vascular Medicine
Background:
- Sickle cell disease (SCD) is associated with increased stroke risk.
- Transcranial Doppler (TCD) is used to assess stroke risk in pediatric SCD.
- Limited data exists on cerebral blood flow in adult SCD patients.
Purpose of the Study:
- To compare intracranial blood flow velocities in adult SCD patients versus controls.
- To evaluate the utility of peak systolic velocity (PSV) and pulsatility index (PI) in adult SCD.
- To identify potential markers for cerebrovascular damage in adult SCD.
Main Methods:
- Fifty-three adult SCD patients (SCD, sickle cell thalassemia, HbS/HbC) and controls underwent TCCD.
- Peak systolic velocity (PSV) in the middle cerebral artery (MCA) was measured with angle correction.
- Pulsatility index (PI) was assessed as an indicator of endothelial elasticity.
Main Results:
- Adult SCD patients exhibited higher MCA-PSV compared to controls (p=0.001).
- Sickle cell anemia patients showed higher PSVs than sickle cell thalassemia and HbS/HbC groups.
- Lower hemoglobin and higher HbS% correlated with higher MCA-PSV; PI remained stable.
Conclusions:
- MCA-PSV and PI are relevant indices for abnormal cerebral blood flow in adult SCD.
- These Doppler parameters may help detect sickle-related endothelial damage.
- Early detection could aid in preventing cerebrovascular accidents in adult SCD.
Abstract:
The threshold velocity ≥200 cm/s at transcranial Doppler (TCD) evaluation is a useful cut-off for preventing the stroke (STOP trial) in pediatric patients with sickle cell disease (SCD), term including different types of sickle genotypes. Scanty data are available for adult SCD patients. We compared intracranial blood flow velocities between adult SCD patients and controls using transcranial color Doppler (TCCD), measuring the peak of systolic velocity (PSV) with the insonation angle correction and the pulsatility index (PI), an indicator of endothelial elasticity. Fifty-three adult SCD patients (aged >18 years) were enrolled (15 sickle cell anemia, 26 sickle cell thalassemia, and 12 HbS/HbC). None of the patients presented neurological signs. PSVs in middle cerebral artery (MCA) were higher in SCD patients than in controls (p = 0.001). In sickle cell anemia patients, PSVs were higher when compared to HbS/βThal (p < 0.0060) and HbS/HbC patients (p < 0.0139). PI was within the lower range of normality in SCD patients compared to controls. Moreover, MCA-PSV was higher with lower Hb levels and higher HbS%; PI did not change with variation of Hb levels and HbS%.PSV and PI in SCD adult patients could be a relevant index to indicate the abnormal cerebral blood flow and to detect the sickle endothelial damage, in order to prevent cerebrovascular accidents.
