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Updated: Aug 28, 2025
Author Spotlight: Assessing Ischemic Stroke Damage Through Middle Cerebral Artery Occlusion Model
Published on: August 11, 2023
Post-reperfusion hyperperfusion after endovascular stroke treatment: a prospective comparative study of TCD versus
Markus Kneihsl1,2, Nicole Hinteregger2, Oliver Nistl2
1Department of Neurology, Medical University of Graz, Graz, Austria.
Background:
Increased middle cerebral artery (MCA) blood flow velocities on transcranial duplex sonography (TCD) were recently reported in individual patients after successful mechanical thrombectomy (MT) and were related to intracranial hemorrhage and poor outcome. However, the retrospective study design of prior studies precluded elucidation of the underlying pathomechanisms, and the relationship between TCD and brain parenchymal perfusion still remains to be determined.
Methods:
We prospectively investigated consecutive patients with stroke successfully recanalized by MT with TCD and MRI including contrast-enhanced perfusion sequences within 48 hours post-intervention. Increased MCA flow on TCD was defined as >30% mean blood flow velocity in the treated MCA compared with the contralateral MCA. MRI blood flow maps served to assess hyperperfusion rated by neuroradiologists blinded to TCD.
Results:
A total of 226 patients recanalized by MT underwent post-interventional TCD and 92 patients additionally had perfusion MRI. 85 patients (38%) had increased post-interventional MCA flow on TCD. Of these, 10 patients (12%) had an underlying focal stenosis. Increased TCD blood flow in the recanalized MCA was associated with larger infarct size, vasogenic edema, intracranial hemorrhage and poor 90-day outcome (all p≤0.005). In the subgroup for which both TCD and perfusion MRI were available, 29 patients (31%) had increased ipsilateral MCA flow velocities on TCD. Of these, 25 patients also showed parenchymal hyperperfusion on MRI (sensitivity 85%; specificity 62%). Hyperperfusion severity on MRI correlated with MCA flow velocities on TCD (rs=0.379, p<0.001).
Conclusions:
TCD is a reliable bedside tool to identify post-reperfusion hyperperfusion, correlates well with perfusion MRI, and indicates risk of reperfusion injury after MT.
Insights
Transcranial duplex sonography (TCD) reliably detects post-mechanical thrombectomy (MT) hyperperfusion, correlating with MRI findings. This bedside tool helps identify patients at risk for reperfusion injury after stroke treatment.
Area of Science:
- Neuroscience
- Medical Imaging
- Interventional Neurology
Background:
- Mechanical thrombectomy (MT) for stroke can lead to increased middle cerebral artery (MCA) blood flow velocities.
- Prior studies, limited by retrospective design, could not fully explain the mechanisms or relationship between TCD findings and brain perfusion.
Purpose of the Study:
- To prospectively investigate the relationship between transcranial duplex sonography (TCD) findings and perfusion MRI in patients after successful MT.
- To determine if elevated MCA flow velocities on TCD indicate parenchymal hyperperfusion and predict outcomes.
Main Methods:
- Prospective study of stroke patients undergoing successful MT, with post-intervention TCD and perfusion MRI within 48 hours.
- MCA flow velocity increase defined as >30% compared to the contralateral side.
- Hyperperfusion assessed by blinded neuroradiologists using MRI blood flow maps.
Main Results:
- 38% of patients (85/226) showed increased MCA flow on TCD post-MT.
- Increased TCD flow correlated with larger infarcts, edema, hemorrhage, and poor 90-day outcomes (p≤0.005).
- In a subgroup (n=92), 85% of those with increased TCD flow also demonstrated parenchymal hyperperfusion on MRI, which correlated with TCD velocities (rs=0.379, p<0.001).
Conclusions:
- Transcranial duplex sonography is a valuable bedside tool for identifying post-reperfusion hyperperfusion after MT.
- TCD findings correlate well with perfusion MRI, aiding in the assessment of reperfusion injury risk.
