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    Doença cerebrovascular em pacientes com síndrome do anticorpo antifosfolípide: avaliação pelo Doppler transcraniano e ressonância magnética
    (Universidade Federal de São Paulo (UNIFESP), 2019-06-27) Ricarte, Irapua Ferreira [UNIFESP]; Silva, Gisele Sampaio [UNIFESP]; Dutra, Lívia Almeida [UNIFESP]; http://lattes.cnpq.br/2916631594056232; http://lattes.cnpq.br/6812788681744190; http://lattes.cnpq.br/6623012368578821; Universidade Federal de São Paulo (UNIFESP)
    Introduction: The potential mechanisms by which a patient with antiphospholipid antibody syndrome (APS) can present with cerebrovascular disease are numerous, including in situ thrombosis and embolism from distant sites. Transcranial Doppler (TCD) may be a useful tool in the evaluation of patients with APS, helping to stratify the risk of cerebrovascular ischemic events in this population. The characteristics of the TCD examination and its correlations with neuroimaging tests in patients with APS had not been previously systematically evaluated. Objectives: To describe the following characteristics of TCD examination: frequency of microembolic signal (MES), frequency of right-left shunt (RLS), presence of intracranial stenosis and cerebral vasomotor reactivity in a group of patients with primary APS (PAPS) and secondary APS (SAPS) in comparison with patients with systemic lupus erythematosus (SLE) and healthy volunteers; to determine the frequency of abnormalities on brain magnetic resonance imaging (MRI) of the studied patients and to correlate these abnormalities with TCD findings; to evaluate the association between history of cerebrovascular disease and TCD findings. Methods: This was a cross-sectional study that evaluated consecutive adult patients with the diagnosis of APS (primary and secondary) comparing with a group of patients with SLE and healthy controls matched by age and sex. All patients with adequate acoustic window were evaluated with a standardized TCD protocol performed by the same neurologist, including: basic exam with evaluation of mean velocities and pulsatility indexes of the intracranial arteries; assessment of cerebral vasoreactivity through the apnea test and microbubble test for RLS detection. After TCD examination, the patients underwent brain MRI. Results: A total of 94 subjects were included in the study (27 patients with SLE, 24 patients with PAPS, 22 patients with SAPS and 21 controls). MES were more frequently found in patients with SLE when compared to controls and patients with APS (PAPS: 4.3%, SAPS: 0%, SLE: 17.4%, controles: 0%, p=0.03). Patients with APS had a higher frequency of RLS when compared to volunteers (63.6% versus 38.1%, p=0.05). Breath holding index (BHI) values tended to be lower in patients with SAPS than in control subjects and patients with PAPS and SLE (p=0.06). Brain MRI findings were similar between the groups, except for the frequency of lacunar infarction, which was higher in patients with SAPS (p = 0.022). Patients with intracranial stenosis detected by TCD had a higher frequency of territorial infarction (40% versus 7.5%, p = 0.02), lacunar infarction (40% versus 11.3%, p=0.075) and borderzone infarction (20% versus 1.9%, p=0.034). Conclusions: Patients with SLE had a higher frequency of MES than patients with APS and healthy controls, which may suggest an effect of anticoagulant therapy used in patients with APS. Patients with APS had a higher frequency of RLS when compared to the control group, which alerts for the need of cardiological investigation in patients with APS and cerebrovascular disease. The frequency of abnormalities in brain MRI was similar between groups, except for the frequency of lacunar infarction. Patients with intracranial stenosis detected by TCD presented a higher frequency of territorial, lacunar and borderzone infarcts, suggesting that the evaluation of the intracranial vasculature should not be neglected in patients with APS and stroke. Key words: antiphospholipid syndrome, transcranial Doppler, microembolic signal, stroke, magnetic resonance, intracranial stenosis, right-left shunt. Methods: This was a cross – sectional study that evaluated consecutive adult patients with the diagnosis of APS (primary and secondary) comparing with a group of patients with SLE and healthy controls matched by age and sex. All patients with adequate acoustic window were evaluated with a standardized TCD protocol performed by the same neurologist, including: basic exam with evaluation of mean velocities and pulsatility indexes of the intracranial arteries; assessment of cerebral vasoreactivity through the apnea test and microbubble test for RLS detection. After TCD examination, the patients underwent brain MRI.