PATTERNS OF TRANSCRANIAL DOPPLER FLOW VELOCITIES AND CAROTID INTIMA MEDIA THICKNESS (CIMT) IN JAVANESE ISCHEMIC STROKE

Rivan Danuaji(1*), Subandi Subandi(2), Arif Apriyanto(3), Endang Kusuma Dewi(4), Suroto Suroto(5), Diah Kurnia Mirawati(6), Pepi Budianto(7), Yetty Hambarsari(8), Baarid Lukman Hamidi(9), Hanindya Riani Prabaningtyas(10), Sulistyani Sulistyani(11)

(1) Students of Medical Science Study Program, Doctoral Degree, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
(2) 1Students of Medical Science Study Program, Doctoral Degree, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
(3) Resident of Neurology, Faculty of Medicine, Universitas Sebelas Maret, Surakarta, Indonesia
(4) Neurology Nurse Staff, Dr Moewardi Hospital, Surakarta, Indonesia
(5) Neurology Staff, Dr Moewardi Hospital and Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
(6) Neurology Staff, Dr Moewardi Hospital and Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
(7) Neurology Staff, Dr Moewardi Hospital and Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
(8) Neurology Staff, Dr Moewardi Hospital and Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
(9) Neurology Staff, Dr Moewardi Hospital and Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
(10) Neurology Staff, Dr Moewardi Hospital and Faculty of Medicine, Universitas Sebelas Maret Surakarta, Indonesia
(11) Neurology Staff, Faculty of Medicine, Universitas Muhammadiyah Surakarta, Indonesia
(*) Corresponding Author

Abstract

ABSTRACT

Intracranial atherosclerosis is the most common cause of stroke in Asia including Indonesia. Transcranial Doppler (TCD) is a noninvasive tool which able to detect intracranial atherosclerosis. The purpose of this study was to determine the pattern of TCD waves in Javanese ischemic stroke patients and Carotid Intima Media Thickness (CIMT), and its correlation to demographic data. This is a cross-sectional study was conducted at Hospital X Surakarta. All Javanese ischemic stroke treated in stroke unit were examine for flow velocity using TCD and CIMT using ultrasound. Chi square was used to analyzes the relationship between age, gender, stroke type and the thickness of CIMT.  A total of 43 ischemic stroke patients were examined for TCD, consisting of 30 (69.77%) men and 13 (30,23%) women. The results showed that 31 (72.09%) had intracranial abnormalities in the form of stenosis or occlusion on MCA (23.26%), ACA (4.65%), PCA (4.65%), vertebral arteries (6.98 %) and other locations (32.56%). Thickening of CIMT was obtained as much as 22 (51,16%) of the patients. Age was a factor associated with CIMT thickening with (P: 0.041), while gender and type of stroke did not (P>0,05)). To sum up Intracranial flow velocity abnormalities often occur in Javanese ischemic stroke patients, while CIMT thickening is not associated with ischemic stroke pathology

Keywords: TCD, Stroke Ischemic, Flow Velocity, CIMT, Javanese

ABSTRAK

Aterosklerosis intrakranial adalah penyebab paling umum dari stroke di Asia termasuk Indonesia. Transcranial Doppler (TCD) adalah alat noninvasif yang mampu mendeteksi aterosklerosis intrakranial. Tujuan dari penelitian ini untuk mengetahui pola gelombang TCD pada pasien stroke iskemik suku Jawa dan Carotid Intima Media Thickness (CIMT), dan korelasinya dengan data demografi. Penelitian cross-sectional ini dilakukan di Rumah Sakit X Surakarta. Semua stroke iskemik suku Jawa yang dirawat di unit stroke diperiksa untuk kecepatan aliran menggunakan TCD dan CIMT menggunakan ultrasound. Chi square digunakan untuk menganalisis hubungan antara usia, jenis kelamin, jenis stroke dan ketebalan CIMT. Sebanyak 43 pasien stroke iskemik diperiksa untuk TCD, terdiri dari 30 (69,77%) pria dan 13 (30,23%) wanita. Hasil penelitian menunjukkan bahwa 31 (72,09%) memiliki kelainan intrakranial dalam bentuk stenosis atau oklusi pada MCA (23,26%), ACA (4,65%), PCA (4,65%), arteri vertebral (6,98%) dan lokasi lain (32,56%). Penebalan CIMT diperoleh sebanyak 22 (51,16%) dari pasien. Usia adalah faktor yang terkait dengan penebalan CIMT dengan (p= 0,041), sedangkan jenis kelamin dan jenis stroke tidak (p> 0,05), sehingga ditarik kesimpulan bahwa kelainan kecepatan aliran intrakranial sering terjadi pada pasien stroke iskemik Jawa, sedangkan penebalan CIMT tidak berhubungan dengan patologi stroke iskemik.

Kata Kunci: TCD, Stroke Iskemik, Flow Velocity, CIMT, Suku Jawa

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References

Banerjee, C. and Chimowitz, M. I. 2017. Stroke Caused by Atherosclerosis of the Major Intracranial Arteries. Circulation Research. doi: 10.1161/CIRCRESAHA.116.308441.

Bang, O. Y. 2014. Intracranial Atherosclerosis: Current Understanding and Perspectives. Journal of Stroke. doi: 10.5853/jos.2014.16.1.27.

Béjot, Y., Bailly, H., Durier, J., Giroud, M. 2016. Epidemiology of stroke in Europe and trends for the 21st century. Presse Medicale. Elsevier Masson SAS, 45(12), pp. e391–e398. doi: 10.1016/j.lpm.2016.10.003.

Itoh, T., Matsumoto, M., Handa, N., Maeda, HH., Hougaku, H., Hashimoto, H., Etrani, H., Tsukamoto, Y., Kamada, T. 1993. Rate of successful recording of blood flow signals in the middle cerebral artery using transcranial doppler sonography. Stroke, 24(8), pp. 1192–1195. doi: 10.1161/01.STR.24.8.1192.

Wong, K.S., Li, H., Chan, Y.L., Ahuja, A., Lam, W.W.,

Wong, A., Kay, R. 2000. Use of transcranial doppler ultrasound to predict outcome in patients with intracranial large-artery occlusive disease. Stroke, 31(11), pp. 2641–2647. Available at: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed5&NEWS=N&AN=2000389072.

Wong, K.S., Ng, P.W., Tang, A., Liu, R., Yeung, V., Tomlinson, B. 2007. ‘Prevalence of asymptomatic intracranial atherosclerosis in high-risk patients’, Neurology, 68(23), pp. 2035–2038. Available at: http://ovidsp.ovid.com/ovidweb.cgi?T=JS&PAGE=reference&D=emed8&NEWS=N&AN=2007274049.

Kamal, A.K., Rehman, H., Mustafa, N., Ahmed, B., Jan, M., Wadivalla, F., and Kamran, S. 2015. Diagnostic TCD for intracranial stenosis in acute stroke patients: Experience from a tertiary care stroke center in Karachi, Pakistan. BMC Research Notes. BioMed Central, 8(1), pp. 15–20. doi: 10.1186/s13104-015-1289-3.

Kemenkes RI. 2009. Tahun 2030 prevalensi diabetes mellitus di Indonesia mencapai 21,3 juta orang. 8 November, pp. 1–2. Available at: http://www.depkes.go.id/pdf.php?id=414.

Kemenkes RI. 2018. Laporan Nasional Riset Kesehatan Dasar (Riskesdas) 2018.pdf. Jakarta. Available at: http://labdata.litbang.depkes.go.id/menu-download.

Lagunju, I., Sodeinde, O. and Telfer, P. 2012. Prevalence of transcranial Doppler abnormalities in Nigerian children with sickle cell disease. American Journal of Hematology, 87(5), pp. 544–547. doi: 10.1002/ajh.23152.

Lin, Y. P., Fu, M. H. and Tan, T. Y. 2015. Factors Associated with No or Insufficient Temporal Bone Window Using Transcranial Color-coded Sonography. Journal of Medical Ultrasound. Elsevier Taiwan LLC and the, 23(3), pp. 129–132. doi: 10.1016/j.jmu.2015.07.002.

Liu, L., Ding, J., Pu, Y., Huang, L., Xu, A., Wong, K.S.W., Wang, X., and Wang, Y. 2018. Guidelines for evaluation and management of cerebral collateral circulation in ischaemic stroke 2017. Stroke and Vascular Neurology. doi: 10.1136/svn-2017-000135.

Londo’o, E. M. L. and Chaturvedi, S. 2016. Stroke due to large vessel atherosclerosis Five new things. Neurology: Clinical Practice. doi: 10.1212/CPJ.0000000000000247.

Oh, H. G., Chung, P. W. and Rhee, E. J. 2015. Increased risk for intracranial arterial stenosis in subjects with coronary artery calcification. Stroke, 46(1), pp. 151–156. doi: 10.1161/STROKEAHA.114.006996.

Ringelstein, E. B., Kahlscheuer, B., Niggemeyer, E., Otis, S.M. 1990. Transcranial doppler sonography: anatomical landmarks and normal velocity values. Ultrasound, 16(8), pp. 745–761.

De Silva, D. A., Woon, F., Lee, M., Chen C. P.L.H., Chang, H., Wong, M. 2007. South Asian patients with ischemic stroke: Intracranial large arteries are the predominant site of disease. Stroke. doi: 10.1161/STROKEAHA.107.484584.

Thorpe, S. G., Thibeault, C.M., Canac, N., Wilk, S.J., Devlin, T., and Hamilton, R.B. 2018. Decision criteria for large vessel occlusion using transcranial Doppler waveform morphology. Frontiers in Neurology, 9(OCT). doi: 10.3389/fneur.2018.00847.

Ultrasound, S. for V. 2017. Intracranial Cerebrovascular Evaluation Transcranial Doppler ( Non-Imaging ) and Transcranial Duplex Imaging ( TCDI ). Available at: www.svunet.org.

Woo, S. Y., Joh, J.H., Han, S., and Park, H. 2017. Prevalence and risk factors for atherosclerotic carotid stenosis and plaque. Medicine, 96(4), p. e5999. doi: 10.1097/md.0000000000005999.

DOI: 10.23917/biomedika.v12i1.9921

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