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Published on: August 9, 2024
Prognostic Value of Cerebral Hemodynamics Assessment on 24-h Transcranial Color-Coded Doppler Following a Successful
Sabrina Rossi1,2, Matteo Paolucci3, Giorgia Arnone3
1Azienda Ospedaliero-Universitaria di Ferrara, University Unit of Neurology, Ferrara, Italy.
Insights
Transcranial color-coded Doppler (TCCD) spectral patterns on day 1 after endovascular thrombectomy (EVT) predict clinical outcomes. A higher Consensus on Grading Intracranial Flow Obstruction (COGIF) score indicates poorer prognosis in stroke patients.
Area of Science:
- Neuroscience
- Vascular Neurology
- Medical Imaging
Background:
- Endovascular thrombectomy (EVT) is a key treatment for acute ischemic stroke.
- Assessing post-EVT cerebral blood flow is crucial for predicting patient outcomes.
- Transcranial color-coded Doppler (TCCD) offers a non-invasive method to evaluate intracranial hemodynamics.
Purpose of the Study:
- To investigate the prognostic value of TCCD spectral patterns after successful EVT.
- To determine the distribution and significance of TCCD findings in relation to clinical outcomes.
Main Methods:
- A multicenter prospective study included 188 patients with successful EVT (mTICI ≥ 2b) within 6 hours.
- TCCD was performed 24-48 hours and 7 days post-EVT, with flow graded using the COGIF score.
- Clinical improvement and 3-month modified Rankin Scale (mRS) were assessed as outcomes.
Main Results:
- Despite successful EVT, 7% of patients showed residual stenosis or incomplete recanalization.
- Day 1 TCCD COGIF scores of 3 (low flow) and 4b (residual stenosis) were significantly associated with lack of clinical improvement and worse 3-month mRS.
- No significant difference in MCA flow velocities was observed between day 1 and day 7 post-EVT.
Conclusions:
- Early post-EVT TCCD assessment using the COGIF score, not just flow velocities, is a significant predictor of clinical outcomes.
- TCCD provides valuable prognostic information in patients treated with EVT for acute ischemic stroke.
Background And Aims:
This study evaluates the distribution and prognostic role of transcranial color-coded Doppler (TCCD) spectral patterns following a successful endovascular thrombectomy (EVT).
Methods:
This multicenter prospective study included patients with internal carotid or middle cerebral artery (MCA) occlusion treated in the early time window (< 6 h) with a successful EVT (mTICI ≥ 2b), without symptomatic hemorrhagic transformation within 24 h. TCCDs were performed 24-48 h and 7 days from EVT. TCCD flow was graded by Consensus on Grading Intracranial Flow Obstruction (COGIF) score (1: no flow; 2-3: low flow; 4a: normal; 4b: residual stenosis; 4c: hyperperfusion). MCA flow velocities were compared between sides and time points. Outcomes were clinical improvement (decrease of 8 points/30% on day 7 NIHSS vs. baseline) and three-month mRS.
Results:
188 ischemic stroke patients were included (48% female, median age 77). The median NIHSS was 16 at admission and 3 at day 7. Day 1 TCCD showed slightly higher velocities in the treated MCA compared to the contralateral MCA, without significant differences between day 1 and day 7. Despite mTICI ≥ 2b, 13/187 (7%) patients showed a partial recanalization or residual stenosis at 24 h. Clinical improvement was lacking in 27 patients (14.4%). COGIF scores 3 and 4b at day 1 were significantly associated with lack of improvement at day 7 (aOR 0.03, 95% CI 0.01-0.16, p < 0.001) and worse mRS score at 3 months (mRS ordinal shift analysis, aOR 7.78, 95% CI 2.16-28.54, p = 0.002).
Conclusions:
Day 1 post-EVT TCCD COGIF score, but no flow velocities alone, are associated with clinical outcomes.
