제2형 당뇨병을 동반한 급성기 열공성 뇌경색에서 박동성 지수의 증가

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