The way to diagnose level of autoregulation of vascular bed vertebrobasilar basin brain

 

(57) Abstract:

The method relates to medicine, namely to methods of diagnosis and functional assessment of the vascular bed. Perform transcranial Doppler sonography. Produce compression of the brachial artery. This was followed by decompression and compare the recovery time linear flow velocity to the initial level by the posterior cerebral artery with its normal time. The method improves the accuracy of diagnosis.

The proposed method relates to medicine, namely to methods of diagnosis and functional assessment of the vascular bed.

The prevalence of occlusive-stenotic lesions of the brachiocephalic arteries reaches 27% in the General structure of vascular diseases. One of the earliest signs of chronic brain ischemia on preclinical stage is impaired autoregulation in carotid and vertebrobasilar basin.

Autoregulatory - the brain's ability to maintain a relatively constant level of blood flow in a wide range of blood pressure. This mechanism is performed by spasm or dilatation of cerebral arterioles. In patients with cerebrovascular lesions, long-term the development of transient ischemic attacks and stroke.

However, to date there is no method for early and accurate assessment of the level of autoregulation in VB.

There is a method of assessment of cerebral autoregulation in carotid pool: on the hips of the patient are superimposed inflatable cuff. After achieving the sustainable location of the middle cerebral artery (David W. Newell, MD, Colleen Douville RVT - The Cerebrovascular Laboratory: Harborview Medical Center and UW Medical Center Seattle, Washington http://depts. washington. edu/uwtcdlab/autoreg.html) or posterior cerebral arteries (Lavrent'ev A. C. Ultrasound diagnosis of intracranial lesions of the cerebral vessels, pages 225-239 in the book. Functional diagnostics in cardiology: Ed. by L. A. Bockeria, E. H. Gorohovoi, A. Century of Ivanitsky. 2 so So 2. - M.: Publishing house Bakulev A. N. Bakulev Russian Academy of medical Sciences, 2003. - S.) hold fast inflating cuff above systolic blood pressure and abrupt release of pressure in them. While systolic systemic pressure transient is reduced by 12-20 mm Od. The velocity of blood flow in the detected arteries also declining for some time, but returned to baseline within a few seconds with intact autoregulation. When the return speed of blood flow passively follows the return of blood pressure (up to several minutes), autoregulatory exhausted. Normal time disadvantages: the test is the system pressure drop, and given that the brain krovosnabzhayutsya in the norm of 4 arteries (2 sleepy 2 vertebrates) and intracranial they all are connected to each other through the so-called "willisau circle", the result is known samples reflects the state of the autoregulation of vascular brain as a whole, despite the fact that locating the study subjected to one particular artery.

The objective of the invention is to increase the specificity and accuracy of diagnosis of the existing level of autoregulation vertebrobasilar basin brain.

The essence of the proposed method lies in the fact that to achieve specificity effects on blood flow in the vertebrobasilar basin at constant rates of blood flow in the carotid arteries, two inflatable arterial cuff placed on both shoulders. By using the apparatus of transcranial Doppler achieve sustainable locations posterior cerebral arteries. After that make simultaneous inflating cuffs, reaching overlapping arterial blood flow in both upper extremities. After sudden decompression of the cuff on the shoulders define the rate of decline of blood flow velocity in the posterior cerebral artery and its cooldown AI in vertebrobasilar basin as normal, and in pathological conditions and lesions of the vertebral arteries, basilar artery and rear cerebral arteries.

The technical result is achieved due to the selective pressure of blood in the vertebral arteries (vertebrobasilar basin) during reactive hyperemia in both upper extremities. Both vertebral arteries depart from the subclavian arteries, the sharp increase of blood flow in the brachial artery causes relative hijacking of blood flow in vertebrate arteries.

The method is as follows: the position of the subject is any. Two inflatable arterial cuff placed on both shoulders. By using the apparatus of transcranial Doppler achieve sustainable locations posterior cerebral arteries. After that producing simultaneous inflating cuffs, reaching overlapping arterial blood flow in both upper extremities. After sudden decompression of the cuff on the shoulders define the rate of decline of blood flow velocity in the posterior cerebral arteries and the time it is restored to the initial level.

Example

Patient K., aged 52. According to the duplex scanning were identified: hemodynamically significant stenosis of the right vertebral who and. The intracranial vessels Department - without hemodynamically significant changes.

For the test to determine the level of autoregulation in the vertebrobasilar basin (UBB) on both shoulders of the patient were imposed pneumatic cuff. After achieving sustainable locations posterior cerebral artery (PCA) using transcranial Doppler, linear blood flow velocity (BFV) which amounted to 28 cm/s, produced simultaneously inflating the cuff to achieve AD above systolic pressure by 20 mm RT. Art. (comprimere brachial artery, we have provided thereby stealing from blood flow in VB).

After a sharp simultaneous deflation of cuffs for permanent monitoring, first right, then left ZMA was registered short-term decrease in BFV right ZMA before 22-21 cm/s, and the time of its restoration to its original level was 10 (when the accepted norm cooldown 51). BFV on ZMA left the original was 25 cm/s, after decompression decreased to 21 cm/s, and the time of recovery to the original BFV was 7 C.

According to the results of the sample can be judged from the decrease in the level of vascular autoregulation in VBB more on the side of hemodynamically significant stenosis allow golovnogo brain, includes compression of the limb arteries, transcranial Doppler, decompression and comparison with normal recovery time linear flow velocity to the initial level, characterized in that the produce compression of the brachial artery, and the recovery time is the linear flow velocity is determined by the posterior cerebral artery.

 

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1 ex, 1 tbl

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4 ex, 1 tbl

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