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Updated: Jun 25, 2025
Point of Care Transcranial Color-Coded Duplex Ultrasound of the Middle Cerebral Artery
Published on: August 9, 2024
Validation of the transcranial Doppler rescue criteria for mechanical thrombectomy
Adnan Khan1, Maher Saqqur2,3, Ashfaq Shuaib4
1Faculty of Allied Health Sciences, Khyber Medical University, Peshawar, Pakistan.
Insights
Transcranial Doppler (TCD) effectively identifies large vessel occlusions in acute stroke patients. This tool shows promise for guiding reperfusion therapies in stroke care.
Area of Science:
- Neuroscience
- Medical Imaging
- Vascular Neurology
Background:
- Acute ischemic stroke often involves arterial occlusion, complicating treatment effectiveness.
- Transcranial Doppler (TCD) is used to assess cerebral blood flow in these patients.
Purpose of the Study:
- To evaluate the clinical utility and prognostic value of TCD in identifying arterial occlusions.
- To assess TCD's role in acute stroke patients undergoing evaluation for reperfusion therapy.
Main Methods:
- Prospective multicenter study (CLOTBUST-PRO) including patients with intracranial occlusion on CTA.
- TCD used to calculate the mean flow velocity (MFV) ratio of the middle cerebral artery (MCA) bilaterally (aMCA/cMCA MFV ratio).
Main Results:
- A mean flow velocity ratio <0.6 demonstrated high sensitivity (99%) for detecting large vessel occlusions (LVO).
- TCD findings, particularly the MFV ratio, showed prognostic value in acute ischemic stroke patients.
- The Thrombolysis in Brain Ischemia scale also provided insights into LVO identification.
Conclusions:
- Transcranial Doppler is a valuable tool for assessing arterial circulation in acute ischemic stroke.
- TCD shows significant potential as a screening tool for reperfusion protocols, including intravenous and intra-arterial lysis.
Background And Purpose:
Transcranial Doppler (TCD) identifies acute stroke patients with arterial occlusion where treatment may not effectively open the blocked vessel. This study aimed to examine the clinical utility and prognostic value of TCD flow findings in patients enrolled in a multicenter prospective study (CLOTBUST-PRO).
Methods:
Patients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA-to-contralateral MCA MFV [aMCA/cMCA MFV ratio]).
Results:
A total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty-eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24-hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of <.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO.
Conclusions:
TCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra-arterial lysis protocols.
