Related Experiment Video
Updated: Jan 16, 2026
Microsurgical Clip Obliteration of Middle Cerebral Aneurysm Using Intraoperative Flow Assessment
Published on: September 25, 2009
Increased middle cerebral artery velocity predicts malignant media infarction after endovascular stroke thrombectomy
Enayatullah Baki1, Victoria Kehl2, Marlene Topka3
1Department of Neurology, School of Medicine and Health, Klinikum Rechts der Isar, Technical University of Munich, Ismaninger Str. 22, Munich 81675, Germany.
Background:
Increased peak systolic velocity (PSV) in transcranial Doppler or Duplex sonography (TCD) of the middle cerebral artery (MCA) after endovascular thrombectomy (EVT) for large vessel occlusion in acute ischemic anterior circulation stroke has been associated with poor functional outcome and increased risk of symptomatic intracranial hemorrhage (ICH).Objective: We evaluated whether increased MCA-PSV is associated with the development of malignant media infarction after EVT.
Methods:
We retrospectively identified all patients who underwent EVT for acute anterior circulation ischemic stroke at our stroke center from January 2021 to July 2024. Increased MCA-PSV on TCD was defined as >30% mean PSV in the treated MCA compared with the contralateral MCA. The development of malignant media infarction was evaluated according to predefined clinical and neuroimaging criteria. Multivariable regression models were used to identify associations between MCA-PSV and the development of malignant media infarction.
Results:
Out of a total cohort of 377 patients, 49 (13.0%) developed malignant media infarction. In multivariable analysis, MCA-PSV increase was significantly associated with malignant media infarction (odds ratio (OR), 53.3 (95% confidence interval (CI): 18.74, 151.54); p < 0.001). Furthermore, the development of malignant media infarction was also associated with secondary ICH (OR, 6.4 (95% CI: 2.16, 19.03); p < 0.001) and higher baseline National Institutes of Health Stroke Scale (OR, 1.25 (95% CI: 1.14, 138); p < 0.001).
Conclusion:
Increased MCA-PSV can act as a predictive marker for the development of malignant media infarction. TCD may serve as a valuable bedside tool in individual risk assessment in early postinterventional surveillance.
Insights
Increased middle cerebral artery (MCA) peak systolic velocity (PSV) after endovascular thrombectomy (EVT) predicts malignant brain swelling. Transcranial Doppler (TCD) can identify stroke patients at high risk for this complication.
Area of Science:
- Neurology
- Vascular Neurology
- Neuroimaging
Background:
- Elevated middle cerebral artery (MCA) peak systolic velocity (PSV) after endovascular thrombectomy (EVT) for acute ischemic stroke is linked to poor outcomes and hemorrhage.
- Malignant brain swelling, a severe complication, requires further investigation regarding predictive markers.
Purpose of the Study:
- To determine if increased MCA-PSV after EVT is associated with the development of malignant brain swelling in patients with acute ischemic stroke.
Main Methods:
- Retrospective analysis of 377 patients undergoing EVT for anterior circulation stroke.
- MCA-PSV increase defined as >30% in the treated MCA compared to the contralateral MCA via transcranial Doppler (TCD).
- Multivariable regression models assessed the association between MCA-PSV and malignant brain swelling development.
Main Results:
- Malignant brain swelling occurred in 13.0% (49/377) of patients.
- Increased MCA-PSV was significantly associated with malignant brain swelling (OR, 53.3; p < 0.001).
- Secondary intracranial hemorrhage and higher NIH Stroke Scale scores were also associated with malignant brain swelling.
Conclusions:
- Increased MCA-PSV serves as a predictive marker for malignant brain swelling post-EVT.
- Transcranial Doppler (TCD) is a valuable bedside tool for early risk assessment in stroke patients.
More Related Videos
07:26Endothelin-1 Induced Middle Cerebral Artery Occlusion Model for Ischemic Stroke with Laser Doppler Flowmetry Guidance in Rat
Published on: February 16, 2013
13:50Focal Cerebral Ischemia Model by Endovascular Suture Occlusion of the Middle Cerebral Artery in the Rat
Published on: February 5, 2011