Validation of the transcranial Doppler rescue criteria for mechanical thrombectomy

Author:

Khan Adnan1ORCID,Saqqur Maher23,Shuaib Ashfaq4,Khan Khurshid4,Sharma Vijay K.5ORCID,Brunser Alejandro67,Eggers Jürgen89,Mikulik Robert1011,Katsanos Aristeidis H.1213ORCID,Sergentanis Theodore N.14,Vadikolias Konstantinos15,Rubiera Marta16,Shahripour Reza Bavarsad1718ORCID,Nguyen Huy Thang19,Martínez‐Sánchez Patricia2021,Safouris Apostolos1221,Heliopoulos Ioannis15,Salam Abdul22,Derksen Carol2,Voumvourakis Konstantinos12,Psaltopoulou Theodora14,Alexandrov Anne W.17,Alexandrov Andrei V.1718,Tsivgoulis Georgios1215ORCID,

Affiliation:

1. Faculty of Allied Health Sciences Khyber Medical University Peshawar Pakistan

2. Trillium Health Partners Mississauga Hospital Mississauga Ontario Canada

3. Department of Medicine University of Toronto Toronto Ontario Canada

4. Division of Neurology Department of Medicine University of Alberta Edmonton Canada

5. Yong Loo Lin School of Medicine, Division of Neurology National University of Singapore National University Hospital Singapore Singapore

6. Unidad de Neurología Vascular Servicio de Neurología Departamento de Neurología y Psiquiatría. Clínica Alemana de Santiago. Facultad de Medicina Clínica Alemana Universidad del Desarrollo Santiago Chile

7. Departamento de Urgencia General. Clínica Alemana de Santiago. Facultad de Medicina Clínica Alemana Universidad del Desarrollo Santiago Chile

8. Department of Neurology University Hospital Schleswig‐Holstein Campus Lübeck Lübeck Germany

9. Department of Neurology Sana Hospital Lübeck Lübeck Germany

10. International Clinical Research Center St. Anne's Hospital Brno Czech Republic

11. Neurology Department Zlin Czech Republic

12. Second Department of Neurology Attikon University Hospital School of Medicine National and Kapodistrian University of Athens Athens Greece

13. Department of Medicine (Neurology) McMaster University & Population Health Research Institute Hamilton Ontario Canada

14. Department of Hygiene Epidemiology, and Medical Statistics School of Medicine National and Kapodistrian University of Athens Athens Greece

15. Department of Neurology University Hospital of Alexandroupolis, Democritus University of Thrace Alexandroupolis Greece

16. Stroke Unit, Department of Neurology Vall d'Hebron University Hospital, Vall d'Hebron Research Institute Barcelona Spain

17. Department of Neurology University of Tennessee Health Science Center Memphis Tennessee USA

18. Department of Neurology University of Alabama at Birmingham Birmingham Alabama USA

19. Department of Cerebrovascular Disease 115 The People Hospital Ho Chi Minh City Vietnam

20. Department of Neurology and Stroke Center IdiPAZ Health Research Institute La Paz University Hospital Autonomous University of Madrid Madrid Spain

21. Torrecardenas Hospital University of Almería School of Health Sciences Almería Spain

22. Department of Epidemiology and Biostatistics King Fahad Specialist Hospital‐Dammam Dammam Saudi Arabia

Abstract

AbstractBackground and PurposeTranscranial Doppler (TCD) identifies acute stroke patients with arterial occlusion where treatment may not effectively open the blocked vessel. This study aimed to examine the clinical utility and prognostic value of TCD flow findings in patients enrolled in a multicenter prospective study (CLOTBUST‐PRO).MethodsPatients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA‐to‐contralateral MCA MFV [aMCA/cMCA MFV ratio]).ResultsA total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty‐eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24‐hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of <.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO.ConclusionsTCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra‐arterial lysis protocols.

Publisher

Wiley

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