Clinical Physiology of Circulation

Chief Editor

Leo A. Bockeria, MD, PhD, DSc, Professor, Academician of Russian Academy of Sciences, President of Bakoulev National Medical Research Center for Cardiovascular Surgery


Радиологические критерии стенозирования брахиоцефальных вен и клиническая выраженность церебрального венозного застоя

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Link: Clinical Physiology of Blood Circulaiton. 2013; (): -

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Abstract

Objective.To estimate the connection of manifestation of clinical symptoms of cerebral venous stagnation and radiological morphological- functional indicators in the condition of brachiocephalic veins stenosis with determination of threshold values of hemodynamic importance.

Material and methods. 105 patients were included in the study with the average age 48.88 ± 9.07 years old. At the examination of the patients by the modes of X-ray diagnostics the brachiocephalic veins stenosis was revealed and verified in the condition of extravasal compression or thrombosis or internal jugular vein hypoplasia. The control group comprised 30 patients at the average age 50.96 ± 4.96 years old. The local, regional and reactive radiological criteria have been considered regarding the hemodynamic significance of disorder of the brachiocephalic veins drainage: stenosis percentage; asymmetry ratio of area and linear velocity (ultrasound scanning); intensity of magnetic resonance signal (MR-angiography); density of blood flow radiocontrast (Multispiral computed tomographic angiography); accumulation of radioindicator (radionuclide scintigraphy) in brachiocephalic veins; peak blood flow systolic velocity in the Rosenthal's basal veins; the sinus rectus and the middle cerebral artery; asymmetry index of peak systolic velocity in the middle cerebral artery; resistance index of the middle cerebral artery and cerebral vascular reactivity index of the middle cerebral artery.

Results. The significant clinical syndromes indicating the cerebral venous stagnation in the condition of obstruction of the brachiocephalic veins are: headache at night and morning time (specific share under clustering 100%), cognitive disorders (81.3 %), asthenia-neurological syndrome (84-100 %), vestibulopathy (72.6-77.8%), epileptic syndrome (66.7 %) and also the sum of syndromes (2-4.75).On the basis of detecting the significant local stenosis(according to NASCET > 70 %) at the extravasal compression, thrombosis or hypoplasia and statistically significant deflection from the norm of the asymmetry ratios of the signal intensity during MR-scanning (≥ 2), drainage velocity in brachiocephalic veins (> 3) as well as the index of cerebral vascular reactivity (≤ 0.45) with decreasing peak velocity in the middle cerebral artery (< 70 cm/s) during the ultrasound examination it is possible to diagnose obstruction of the brachiocephalic veins as a cause of cerebral venous stagnation. Sufficient correlation (≥ 0.4) of these radiological and clinical symptoms has made them significant in diagnosing of the cerebral venous stagnation in the condition of obstruction of brachiocephalic veins.

Conclusion. The recommendation of preferable distinguishing the manifested stagnation from the non-manifested has been reported as a result of mathematical verification of the classification of staged development of the intracranial venous stagnation in the condition of obstruction of brachiocephalic veins.

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