V. Zetola
Federal University of Parana – Curitiba, Brazil

Stroke is an important complication of sickle cell disease. Approximately twenty-four percent of patients have a stroke by the age of 45 years. Blood transfusions decrease stroke risk in patients deemed high risk by transcranial Doppler (TCD) by evidence of elevated intracranial internal carotid or middle cerebral artery velocity. A follow-up of neurologically symptomatic and asymptomatic sickle cell patients increased other factors were significant in the identification of patients at risk that could include: velocity in the ophthalmic artery > that of the ipsilateral MCA, maximum velocity in the posterior cerebral (PCA), vertebral, or basilar arteries > maximum velocity in the MCA, turbulence, PCA visualized without the MCA.

These news observations in TCD exams have been included in a practical way and will be discussed. TCD screening itself only stratifies stroke risk, but does not prevent stroke; stroke prevention depends on the implementation of chronic transfusion therapy. However, access to vascular laboratories appears to be a barrier to the implementation of this highly effective stroke prevention strategy, even among children with comprehensive health insurance. The difficulties in performing the examination, differences in imaging and nonimaging techniques, and interpretation guidelines are the main problems. This review describes the practical procedure, the strategies to improve the TCD utilization like task force works and illustrates with the Brazilian guidelines a prevalent place for this disease.

Key words: sickle cell disease, stroke prevention, transcranial Doppler, thrombosis.

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