Repeat transcranial Doppler ultrasound imaging in Kuwaiti children with sickle cell disease after a 10-year interval: A prospective, cohort study

Objectives: Transcranial Doppler imaging (TCDI) of the cerebral arteries is the method of choice to predict patients with sickle cell disease (SCD) at risk for stroke. This study reports TCDI follow-up of cerebral blood flow in a cohort of Kuwaiti children with SCD after a 10-year interval. Methods: Twenty-one pediatric patients with SCD, aged 16.0 ± 1.6 years were initially studied when they were aged 6.5 ± 1.2 years. TCDI scanning was carried out using a phased-array transducer of 1–3 MHz through the trans-temporal window. Peak systolic velocity (PSV), end-diastolic velocity (EDV), time-averaged mean of the maximum velocity (TAMMV), resistive index (RI), and pulsatility index (PI) were obtained in the anterior and posterior Circle of Willis vessels. Results: The follow-up indices were mostly lower than in the initial study although they remained within the normal range in all the arteries. TAMMV was less than 170 cm/s, and PSV did not exceed 200 cm/s in all vessels. The initial and follow-up TAMMV (mean ± SD) were: 77.3 ± 20.9 and 71.6 ± 9.9 in the terminal internal carotid artery, 94.3 ± 25.8 and 82 ± 18.2 in the middle cerebral artery, 76.6 ± 25.6 and 70.6 ± 10.7 in the anterior cerebral artery, and 59.1 ± 15.8 and 63.9 ± 8.5 in the posterior cerebral artery, respectively. The mean differences between the old and follow-up data for RI, and PI were statistically significant (p < 0.05). Conclusions: Kuwaiti patients with SCD appear to be largely protected from cerebral artery vasculopathy in childhood.