Transcranial Doppler After Successful Endovascular Revascularization and Hospitalization Outcomes

Abstract

Background Almost half of large‐vessel occlusion strokes have unfavorable outcomes despite successful endovascular therapy. We aim to investigate whether postrevascularization cerebral hemodynamics, determined by transcranial Doppler (TCD), associate with hospitalization outcomes in this population. Methods The current observational cohort study analyzed 155 patients with successfully revascularized anterior circulation large‐vessel occlusion stroke (mean age, 68.3±15.4 years; 55% women) who had TCD within 48 hours from endovascular therapy. TCD parameters (mean flow velocity, peak systolic velocity, and pulsatility index) were recorded at the ipsilateral middle cerebral artery, and blood flow signals were categorized using the Thrombolysis in Brain Ischemia grades into normal (grade 5), stenotic (grade 4), or dampened (grade ≤3). Hospitalization outcomes comprised favorable discharge modified Rankin Scale score (0–2), favorable discharge destination (home or acute inpatient rehabilitation), and in‐hospital mortality. Logistic regression models adjusted for age, initial National Institutes of Health Stroke Scale score, and Alberta Stroke Program Early CT [Computed Tomography] Score were fit to determine TCD findings in association with study outcomes. Results Abnormal TCD‐derived blood flow was found in 54 (35%) cases, including 35 (23%) with Thrombolysis in Brain Ischemia grade 4 and 19 (12%) with Thrombolysis in Brain Ischemia grade ≤3. Overall, 31% had favorable discharge modified Rankin Scale score, 65% had favorable destination, and 14% died. Thrombolysis in Brain Ischemia grade ≤3 was associated with lower likelihood of both favorable discharge modified Rankin Scale score (adjusted odds ratio [OR], 0.09 [95% CI, 0.01–0.81]) and favorable destination (adjusted OR, 0.22 [95% CI, 0.07–0.71]). Mean flow velocity and peak systolic velocity were not associated with study outcomes. Conversely, increased pulsatility index was inversely associated with favorable destination (adjusted OR, 0.34 [95% CI, 0.13–0.87]). Conclusions TCD after successful endovascular therapy identified abnormal blood flow in one‐third of cases. Dampened flow and markers of increased microvascular resistance were associated with unfavorable hospitalization outcomes. TCD could provide valuable prognostic information in this population and identify potential therapeutic targets.

Keywords

• acute ischemic stroke
• large‐vessel occlusion
• transcranial Doppler