Abstract
Background and purpose
Some acute stoke patients have a poor outcome despite successful arterial recanalization.
We hypothesized that transcranial Doppler (TCD) findings from the rescued artery might
predict poor outcome in patients with recanalization.
Methods
Acute stroke patients treated with internal carotid artery or middle cerebral artery
(MCA) occlusions with follow-up TCD examination after intra-arterial (IA) intervention
were retrospectively analyzed. Only patients with at least a Thrombolysis In Myocardial
Infarction (TIMI) flow grade ≥2 in the MCA territory were included. Mean flow velocity (MFV) and pulsatility index
(PI) of the rescued MCA were obtained by TCD. Poor clinical outcome was defined as
in-hospital death or decompressive craniectomy.
Results
Among 50 patients, there were 8 (16%) in the Poor Outcome group and 42 (84%) in the
Non-poor Outcome group. TCD was conducted at a median of 1 day (interquartile range, 1–1) after IA therapy. Although MCA MFV was not different
between the two groups, MCA PI was significantly higher in the Poor Outcome group
than in the Non-poor Outcome group (1.3 [1.1–1.7] vs. 0.8 [0.7–1.1], p = 0.002). After adjusting for the National Institutes of Health Stroke Scale score on
admission, the Alberta Stroke Programme Early Computed Tomography score, a past history
of coronary artery disease and the Thrombolysis In Brain Ischemia grade, MCA PI was
an independent predictor of poor outcome (odds ratio: 1.71, 95% confidence interval:
1.10–2.66, p = 0.017).
Conclusion
Follow-up TCD examination after IA intervention in acute stroke patients may predict
poor outcome beyond angiographic residual TIMI flow.
Keywords
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Article info
Publication history
Published online: August 15, 2013
Accepted:
July 17,
2013
Received in revised form:
July 12,
2013
Received:
May 3,
2013
Identification
Copyright
© 2013 Elsevier B.V. Published by Elsevier Inc. All rights reserved.
