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Updated: Jul 11, 2026
Optimized Management of Endovascular Treatment for Acute Ischemic Stroke
Published on: January 18, 2018
The Eligible study: ultrasound assessment in acute ischemic stroke within 3 hours
Giovanni Malferrari1, Chiara Bertolino, Federica Casoni
1Neurology Department, Arcispedale S. Maria Nuova, Reggio Emilia, Italy.
Insights
Transcranial color-coded duplex sonography (TCCD) helps identify stroke-related vessel occlusions early. This method predicts patient outcomes and tracks recanalization, offering valuable insights for acute stroke management.
Area of Science:
- Neuroimaging
- Vascular Neurology
- Medical Ultrasound
Background:
- Early identification of vessel occlusion patterns is crucial for acute stroke management.
- Understanding recanalization dynamics aids in predicting patient prognosis.
Purpose of the Study:
- To identify vessel occlusion patterns using echo color Doppler ultrasound and TCCD within 3 hours of stroke onset.
- To compare clinical findings and outcomes across different occlusion groups.
- To study the recanalization process independent of therapy.
Main Methods:
- Enrolled 89 stroke patients, performing ultrasound evaluations within 3 hours of stroke onset and at follow-up intervals (3-6h, 24-36h, day 5, 3 months).
- Classified patients into groups based on occlusions/stenoses in supra-aortic vessels (internal carotid, middle cerebral arteries) and T-occlusions.
- Assessed recanalization, comparing subgroups using NIH Stroke Scale (NIHSS), mortality, Barthel Index (BI), and modified Rankin Scale (mRS).
Main Results:
- Significant differences observed across subgroups in baseline NIHSS, 3-month mortality, BI at day 5, and 3-month mRS, even after adjusting for treatment.
- T-occlusions and tandem occlusions showed the highest NIHSS scores and poorest outcomes.
- These subgroups also exhibited the lowest recanalization rates.
Conclusions:
- TCCD is effective in the acute stroke setting for identifying clot presence and location.
- TCCD aids in predicting patient outcomes and monitoring vessel recanalization dynamics.
- The study highlights TCCD's utility in both acute and follow-up phases of stroke care.
Aims Of The Study:
to identify with echo color Doppler ultrasound of the supra-aortic vessels and transcranial color-coded duplex sonography (TCCD) various patterns of vessel occlusion within 3 h from stroke onset, to compare each group defined at the admission with clinical findings and outcome, and to study the recanalization process, independent of therapy.
Methods:
We enrolled 89 consecutive patients (mean age 68.9 years). Ultrasound evaluation was done within 3 h from stroke onset, and was repeated at 3-6 and 24-36 h, at day 5, and at 3 months. At admission, patients were divided into the following groups: internal carotid artery occlusions and stenoses (<50%, 50-69%, > or =70%, near occlusion), middle cerebral artery stenoses and occlusions, tandem occlusions and T occlusions. Vascular recanalization in each group was evaluated. Subgroups were compared for NIH Stroke Scale (NIHSS) and the outcome measures mortality, Barthel index (BI) and modified Rankin scale (mRS). Favorable outcome was defined as mRS < or =2 and BI > or =90.
Results:
Each subgroup differed significantly for baseline NIHSS (p < 0.0001), 3-month mortality (p = 0.0235), BI at day 5 (p = 0.0458) and mRS at 3 months (p = 0.0028), even after adjustment for treatment. T and tandem occlusions were the subgroups with the highest NIHSS scores and the poorest outcomes, and the same subgroups had the worst recanalization rates.
Conclusions:
TCCD in the acute setting of stroke patients allows identification of the presence and site of clots, prediction of outcome and study of the dynamic process of vessel recanalization, in both the acute phase and follow-up.
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