Point-of-care ultrasound of the common carotid arteries for detection of large vessel occlusion stroke: Results of the POCUS-LVO study.

Abstract

Introduction: Distal arterial occlusions can cause measurable changes in the flow wave profile in proximal segments of the feeding artery. Our objective was to study the diagnostic accuracy of point-of-care ultrasound (POCUS) of the common carotid arteries (CCA) for detection of anterior circulation large vessel occlusion (ac-LVO) in patients with suspected stroke.

Patients and methods: We conducted a prospective, single-center, observational study of adult patients with suspected stroke admitted in the emergency department. Flow wave profiles of both CCAs were generated by non-specialists using POCUS as soon as possible after admission. ac-LVO was defined as an internal carotid artery or M1 occlusion in CT- or MR-angiography. The diagnostic performances for detection of ac-LVO using flow wave parameters were calculated.

Results: Among 283 patients recruited during a 10-month period, 257 patients (91%) had CCA ultrasound images of sufficient quality and were included for analysis. The mean age was 75 years (IQR 62-83), 131 were female (51.0%), median baseline NIHSS was 2 (IQR 0-5). The most frequent final diagnosis was ischemic stroke (49.4%), ac-LVO was present in 30 patients (11.9%). The median duration of POCUS was 3 min (IQR 2-5). Among all flow wave parameters, the highest diagnostic accuracy for ac-LVO detection was found for end-diastolic velocity difference between sides (AUC = 0.90, 95%CI = 0.85-0.93), with a specificity of 83% (95%CI = 78-88%) at a predefined sensitivity threshold of 80%.

Discussion and conclusion: POCUS of the CCA in patients with suspected stroke can predict the presence of ac-LVO. These results need to be replicated in a prehospital setting.