Transcranial Doppler 6 h after Successful Reperfusion as a Predictor of Infarct Volume

• Published in: Journal of stroke and cerebrovascular diseases Vol. 31; no. 1; p. 106149
• Main Authors: Gómez-Escalonilla, Carlos, Simal, Patricia, García-Moreno, Hector, Sánchez, Talía Liaño, Canalejo, Diego Mayo, Jiménez, María Romeral, Hernández, Lorenzo Silva, Alfocea, Daniel Toledo, Moreu, Manuel, Pérez-García, Carlos, Rosati, Santiago, Egido, Jose Antonio
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.01.2022
• Subjects: Acute ischemic stroke; Aged; Cerebral hyperperfusion; Endovascular treatment; Female; Humans; Infarct volume; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - physiopathology; Ischemic Stroke - diagnostic imaging; Ischemic Stroke - physiopathology; Ischemic Stroke - surgery; Male; Predictive Value of Tests; Prospective Studies; Reperfusion; Successful reperfusion; Transcranial doppler; Treatment Outcome; Ultrasonography, Doppler, Transcranial; Successful reperfusion; Endovascular treatment; Transcranial doppler; Acute ischemic stroke; Infarct volume; Cerebral hyperperfusion
• ISSN: 1052-3057; 1532-8511
• DOI: 10.1016/j.jstrokecerebrovasdis.2021.106149

The aim of the study is to analyze the hemodynamic changes in the middle cerebral artery (MCA) after endovascular revascularization in acute ischemic stroke (AIS) due to large vessel occlusion and its association with the infarct volume size in the control head CT. Prospective study of patients with AIS due to internal carotid artery terminus or M1 segment of the MCA occlusion, who underwent endovascular treatment with a final TICI 2b-3 score, without concomitant stenosis ≥50% in both cervical carotid arteries. Transcranial Doppler ultrasound (TCD) of both MCAs was carried out at 6 h after the endovascular procedure. Mean flow velocities (MFV) after arterial reperfusion and its association with the infarct volume size in 24−36 h control head CT were determined. 91 patients (51 women) were included with a median age of 78 years and National institute of Health Stroke Scale of 18. The MCA was occluded in 76.92%, and intravenous thrombolysis was administered in 40.7%. The incidence of symptomatic intracranial hemorrhage was 5.5%. At three months, mortality was 19.8% and a 52.7% of patients achieved functional independence (modified Rankin Scale 0-2). After a multivariable logistic regression analysis, an increase in the MFV greater than 50% at 6 h in the treated MCA compared to contralateral MCA, was an independent predictor of large infarct volume in the control head CT with an OR 9.615 (95%CI: 1.908−47.620), p=0.006 Increased MFV assessed by TCD examination following endovascular recanalization is independently associated with larger infarct volume