r-n-jРоссийский неврологический журналRussian neurological journal2658-79472686-7192МИА10.30629/2658-7947-2023-28-2-38-45r-n-j-412Research ArticleИССЛЕДОВАНИЯ И КЛИНИЧЕСКИЕ НАБЛЮДЕНИЯCLINICAL RESEARCHES AND CASE REPORTSДиагностические критерии определения вида право-левого шунта при контрастной транскраниальной доплерографии у молодых пациентов с ишемическим острым нарушением мозгового кровообращенияDiagnostic criteria for determining the type of the right-to-left shunt using contrast-enhanced transcranial Doppler ultrasound in young patients with ischemic stroke/transient ischemic attackhttps://orcid.org/0000-0002-0274-9694КаршиеваА. Р.KarshievaA. R.

Каршиева Алина Равшановна

Москва

Alina R. Karshieva

Moscow

alinakarshieva@yandex.ruhttps://orcid.org/0000-0002-8726-8928ЧечеткинА. О.ChechetkinA. O.

Москва

Moscow

andreychechetkin@gmail.comhttps://orcid.org/0000-0003-3124-2443БелопасоваА. В.BelopasovaA. V.

Москва

Moscow

mastusha@yandex.ruhttps://orcid.org/0000-0001-9929-2725ДобрынинаЛ. А.DobryninaL. A.

Москва

Moscow

dobrla@mail.ruФГБНУ Научный центр неврологииРоссияResearch Center of NeurologyRussian Federation2023180520232823845Copyright © Каршиева А.Р., Чечеткин А.О., Белопасова А.В., Добрынина Л.А., 20232023Каршиева А.Р., Чечеткин А.О., Белопасова А.В., Добрынина Л.А.Karshieva A.R., Chechetkin A.O., Belopasova A.V., Dobrynina L.A.Данная работа распространяется под лицензией Creative Commons Attribution 4.0.This work is licensed under a Creative Commons Attribution 4.0 License.https://www.r-n-j.com/jour/article/view/412Цель исследования

Цель исследования. Определить специфические диагностические критерии для выявления вида право-левого сброса при контрастной транскраниальной доплерографии (кТКД) у молодых пациентов с парадоксальной эмболией и ишемическим острым нарушением мозгового кровообращения.

Материал и методы

Материал и методы. В исследование вошли 64 пациента (28–44 года) с ишемическим инсультом или транзиторной ишемической атакой, имеющих открытое овальное окно (ООО), дефект межпредсердной перегородки (ДМПП) или легочную артериовенозную мальформацию (лАВМ). С помощью кТКД оценивались категория шунта и ее изменение при проведении пробы Вальсальвы (ПВ); время появления первого микроэмболического сигнала (МЭС); продолжительность регистрации МЭС.

Результаты

Результаты. По данным кТКД у 20% пациентов с ООО шунтирование в покое отсутствовало, 80% имели незначительный или умеренный право-левый сброс. После проведения ПВ у 75% больных этой группы был выявлен выраженный шунт и у 25% — умеренный шунт. У всех пациентов с ДМПП и лАВМ в покое отмечалось выраженное шунтирование крови. Время появления первого МЭС от начала введения контраста во всех группах статистически не различалось. Продолжительность шунтирования МЭС была меньше у пациентов с ООО по сравнению с больными с ДМПП (р < 0,001) или с лАВМ (р < 0,001), а у пациентов с лАВМ — значительно дольше, чем у больных с ДМПП (р < 0,001).

Заключение

Заключение. Ключевыми диагностическими критериями для определения вида право-левого шунта являются функциональная категория шунта в покое и продолжительность шунтирования МЭС. При регистрации выраженного сброса в покое можно предполагать наличие ДМПП или лАВМ, а продолжительность шунтирования МЭС более 2 мин позволяет предположить лАВМ.

Objective

Objective. To determine specific diagnostic criteria for detecting the type of the right-to-left shunt by contrast-enhanced transcranial Doppler ultrasound (cTCD) in young patients with paradoxical embolism and ischemic stroke/TIA.

Material and methods

Material and methods. The study included 64 ischemic stroke or transient ischemic attack patients (age 28–44 years) with patent foramen ovale (PFO), atrial septal defect (ASD) or pulmonary arteriovenous malformation (PAVM). cTCD was used to assess the degree of shunting, its change during the Valsalva maneuver (VM), time to the fi rst microembolic signal (MES) detection, and the duration of MES registration.

Results

Results. According to cTCD data, 20% of patients with PFO had no shunt at rest, and 80% had a mild to moderate right-to-left shunt. After VM, a severe shunt was detected in 75% of patients in this group and a moderate shunt in 25%. All patients with ASD and PAVM had a marked shunt at rest. The difference in time to first MES detection from the start of contrast administration was not statistically significant for all groups. The duration of MES registration that indicated shunting was shorter in patients with PFO compared to those with ASD (p < 0.001) or with PAVM (p < 0.001) and it was significantly longer in patients with PAVM compared to those with ASD (p < 0.001).

Conclusion

Conclusion. The key diagnostic criteria to defi ne the right-to-left shunt type are the functional shunt degree at rest and the duration of MES registration. Severe shunting at rest can suggest the presence of ASD or PAVM, while the duration of MES registration > 2 min suggests a PAVM.

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The authors declare that there are no conflicts of interest present.