Changes in Cerebral Hemodynamics and Efficacy of Revascularization Procedures in Ischemic Stroke

Abstract

Introduction

We evaluated the possibility of identifying predictors of efficacy of revascularization treatments in patients with acute ischemic stroke (AIS) through mean flow velocity (MFV) changes in middle cerebral arteries (MCAs).

Patients and Methods

Color-coded transcranial Doppler ultrasound (TCCD) was used to assess vessel status and cerebral hemodynamics of 40 consecutive AIS patients (19 females [47.5%], median age 72 years) with distal occlusion of the internal carotid artery (ICA) or MCA immediately after reperfusion treatments.

Results

Proximal occlusion was observed in 80% of cases. Seventy-five percent of cases had successful recanalization, defined as Grade 2b or 3 score at the modified thrombolysis in cerebral infarction (mTICI), while partial recanalization (Grade 2a mTICI) was achieved in 17.5%. Ipsilateral MFV in the mTICI 2b-3 subgroup was 86.1 ± 14.2 and 64.2 ± 6.2 cm/s in the contralateral side (p < 0.05, t-test for independent samples). In patients with other mTICI values, there was no statistically significant difference in MFV values between the sides. The MFV ratio (MFV of occluded side/contralateral MFV) was significantly associated with NIHSS improvement after 3 months.

Discussion and Conclusions

Higher MFV values in the vessel undergoing mechanical thrombectomy compared with the contralateral side are associated with successful revascularization. The increase in MFV was statistically significant in cases involving the distal ICA and proximal segment of the MCA (M1) and nonsignificant in cases involving the distal segment of the vessel (M2). Performing a TCCD examination in stroke patients can be a valuable bedside approach to evaluate the effectiveness of treatments.