title: Post-intervention TCD examination may be useful to predict outcome in acute ischemic stroke patients with successful intra-arterial intervention.
abstract: OBJECTIVE
  Some acute stoke patients have a poor outcome despite successful arterial recanalization. We hypothesized that transcranial Doppler (TCD) findings from the rescued artery might predict poor outcome in patients with recanalization.
  
  
  METHODS
  Acute stroke patients treated with internal carotid artery or middle cerebral artery (MCA) occlusions with follow-up TCD examination after intra-arterial (IA) intervention were retrospectively analyzed. Only patients with at least a Thrombolysis In Myocardial Infarction (TIMI) flow grade ≥ 2 in the MCA territory were included. Mean flow velocity (MFV) and pulsatility index (PI) of the rescued MCA were obtained by TCD. Poor clinical outcome was defined as in-hospital death or decompressive craniectomy.
  
  
  RESULTS
  Among 50 patients, there were 8 (16%) in the Poor Outcome group and 42 (84%) in the Non-poor Outcome group. TCD was conducted at a median of 1 day (interquartile range, 1-1) after IA therapy. Although MCA MFV was not different between the two groups, MCA PI was significantly higher in the Poor Outcome group than in the Non-poor Outcome group (1.3 [1.1-1.7] vs. 0.8 [0.7-1.1], p = 0.002). After adjusting for the National Institutes of Health Stroke Scale score on admission, the Alberta Stroke Programme Early Computed Tomography score, a past history of coronary artery disease and the Thrombolysis In Brain Ischemia grade, MCA PI was an independent predictor of poor outcome (odds ratio: 1.71, 95% confidence interval: 1.10-2.66, p = 0.017).
  
  
  CONCLUSIONS
  Follow-up TCD examination after IA intervention in acute stroke patients may predict poor outcome beyond angiographic residual TIMI flow.
authors: Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH, USA. Electronic address: aojyun@med.kawasaki-m.ac.jp.
authors: Junya
authors: J
authors: Aoki
authors: Larry N
authors: LN
authors: Raber
authors: Irene L
authors: IL
authors: Katzan
authors: Muhammad Shazam
authors: MS
authors: Hussain
authors: Ferdinand K
authors: FK
authors: Hui
authors: Ken
authors: K
authors: Uchino
mesh_terms: D000368:Aged; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000188:drug therapy; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012720:Severity of Illness Index; D020521:Stroke / Q000000981:diagnostic imaging* / Q000188:drug therapy; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D016896:Treatment Outcome; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D010959:Tissue Plasminogen Activator
keywords: Acute ischemic stroke; Intra-arterial intervention; Poor outcome; Pulsatility index; Recanalization; Transcranial Doppler