Posterior Circulation Evaluation in Patients with Sickle Cell Anemia

• Published in: Journal of stroke and cerebrovascular diseases Vol. 25; no. 3; pp. 717 - 721
• Main Authors: Adegoke, Samuel Ademola, MD, MPH, Figueiredo, Maria Stella, MD, PhD, Vicari, Perla, MD, PhD, Carrete, Henrique, MD, PhD, Idagawa, Marcos Hideki, MD, Massaro, Ayrton Roberto, MD, PhD, Silva, Gisele Sampaio, MD, MPH PhD
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01-03-2016
• Subjects: Adolescent; Adult; Anemia, Sickle Cell - diagnostic imaging; Anemia, Sickle Cell - physiopathology; Blood Flow Velocity - physiology; Cardiovascular; Case-Control Studies; Cerebrovascular Circulation - physiology; Female; Humans; intracranial stenoses; Magnetic Resonance Angiography; Magnetic Resonance Imaging; Male; Neurology; Outpatients; posterior circulation; Sickle cell anemia; Statistics as Topic; stroke; transcranial Doppler; Ultrasonography, Doppler, Transcranial; Young Adult; magnetic resonance imaging; Sickle cell anemia; transcranial Doppler; intracranial stenoses; posterior circulation; stroke
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2015.11.007

Background The role of transcranial Doppler (TCD) ultrasonography in identifying children with sickle cell anemia (SCA) at risk for stroke is well known; however, the major studies that evaluated TCD velocities in children with SCA did not report posterior circulation evaluation data. The objective of our study was to describe the pattern of blood flow velocities in the posterior circulation of patients with SCA and to examine their relationship with findings on magnetic resonance imaging (MRI)/magnetic resonance angiography (MRA). Methods All adult patients with SCA followed in the outpatient clinic of our hospital were evaluated with TCD and MRI/MRA. The highest velocities of the middle cerebral arteries or internal carotid arteries were taken as the time-averaged maximum mean (TAMM) velocity for each patient and the maximum mean flow velocities in the posterior circulation (TAMMpost) were recorded. Results Fifty-six patients with SCA and 56 healthy nonanemic volunteers were evaluated. The mean TAMMpost in the basilar, vertebral, and posterior cerebral arteries (PCAs) were significantly higher among cases than controls ( P  < .01). In patients with SCA, the TAMMpost in all posterior circulation arteries had a positive correlation with TAMM. Only 1 patient with stenosis in the posterior circulation (right PCA) was identified. Conclusion We found a low frequency of stenosis but high blood flow velocities in the posterior circulation in patients with SCA. The role of increased TCD velocities in the posterior circulation upon stroke risk in patients with SCA should be further examined.