Determination of cerebral blood flow velocity and microembolic signals in essential thrombocytosis by transcranial doppler ultrasonography

ABSTRACT

Objectives

The goal of treatment in essential thrombocytosis (ET) is to prevent vascular complications such as thrombosis and hemorrhage. This study aimed to evaluate the risk of cerebrovascular microembolism in ET patients due to detection of microembolic signals (MES) and measure cerebral blood flow velocity (CBFV) by Transcranial Doppler (TCD) ultrasonography.

Material and Methods

In this prospective case-control study, forty patients with diagnosed ET and age and sex-matched forty healthy controls were examined by the TCD sonography.

Results

The ET group had a higher rate of MES (8/40) in the right MCA than that in the control group (none), as measured by TCD. Five patients had MES at the left MCA compared to that in no subjects in the control group. The comparison of the ET and control groups in terms of CBFV parameters showed significantly lower end-diastolic FV at the right MCA in the ET group compared to that in the control group (p < 0.05). On the other hand; both pulsatility and resistance indices in the right and left MCA and the ratios of systolic to diastolic blood flow rates in the right and left MCA were significantly higher in the ET group than that in the control group.

Discussion

This study revealed that MES seems to be more common in patients with ET despite treatment. We could suggest that ET patients should be monitored more closely to address the potential risk of developing a cerebrovascular disease, which can be estimated by detection MES and raised CBFV, combine antiplatelet therapies to standard treatments.

KEYWORDS:

• cerebral blood flow velocity
• cerebrovascular diseases
• essential thrombocytosis
• microembolic signals
• transcranial doppler ultrasonography

Acknowledgments

Ethics Statement: Our trial was conducted upon being approved by the Ethics Committee of the School of Medicine of Bezmialem Vakif University (Ethics Committee approval date: 19.03.2014, Ethics Committee number: 6/9). All patients gave written informed consent forms and the study was conducted according to the 2009 Helsinki Declaration. This work was supported by the Scientific Research Project Foundation founded by BezmiAlem Vakif University (Decision No: 12.2013/26).

Disclosure statement

The authors declare no conflict of interest.

Additional information

Funding

This work was supported by the Bezmiâlem Vakif Üniversitesi [12.2013/26].

Notes on contributors

Ahmet Cinar

Ahmet Cinar works as an internal medicine specialist at Arnavutkoy State Hospital. He has conducted various studies on the clinical course of acute pancreatitis, the role of platelet indices in the occurrence of complications in acute appendicitis and drug-related acute renal failure. In his thesis, he examined flow velocity and microembolic signals in essential thrombocytosis patients.

Guven Cetin

Guven Cetin works as a hematologist at Bezmialem Foundation University, Istanbul, Turkey. His studies focused on myeloproliferative diseases and hematological malignancies, especially lymphomas and multiple myeloma.

Ozge Altintas Kadirhan

Ozge Altintas Kadirhan works as a neurologist at Beykent University. Her research interest lies in the area of vascular neurology, neuroprotection, blood brain barrier and epigenetic modulation in CNS and her projects have been guided by ischemic stroke treatments and experimental model.

Seda Turgut

Seda Turgut works as an internalist and endocrinologist at Health Science University Bakırkoy Dr. Sadi Konuk Training and Research Hospital, Istanbul, Turkey. Her studies focused on hematological and endocrinological diseases; in particular, she also interests in statistical analysis, and she has supported our study in these respects.

Iskender Ekinci

Iskender Ekinci works as an internal medicine specialist at Kanuni Sultan Suleyman Training and Research Hospital, Istanbul, Turkey. Besides focusing on diabetes and endothelial dysfunction in his academic researches, he also interested in topics within the scope of nephrology and gastroenterology.

Talip Asil

Talip Asil works as a vascular neurologist at Memorial Hospital. His research interest lies in the area of vascular neurology, neuroprotection, and his projects have been guided by ischemic stroke treatments model.