Claudio Baracchini1, Filippo Farina2, Anna Palmieri2, Caterina Kulyk2, Alessio Pieroni2, Federica Viaro2, Giacomo Cester2, Francesco Causin2, Renzo Manara2. 1. From the Stroke Unit and Neurosonology Laboratory (C.B., F.F., A.P., C.K., A.P., F.V.), Department of Neuroscience, and Neuroradiology Unit (G.C., F.C., R.M.), University of Padua School of Medicine, Italy. claudiobaracchini@gmail.com. 2. From the Stroke Unit and Neurosonology Laboratory (C.B., F.F., A.P., C.K., A.P., F.V.), Department of Neuroscience, and Neuroradiology Unit (G.C., F.C., R.M.), University of Padua School of Medicine, Italy.
Abstract
OBJECTIVE: To find early hemodynamic predictors of outcome and reperfusion injury in patients with acute ischemic stroke due to anterior circulation large artery occlusion (LAO) after endovascular treatment (EVT). METHODS: Serial transcranial color-coded sonography examinations assessed the vessel status and cerebral hemodynamics of 185 (109 [58.9%] men, mean age 69.5 ± 12.3 years) consecutive patients with acute anterior circulation LAO soon after, at 48 hours after, and 1 week after EVT. RESULTS: Successful recanalization (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.11-0.61) and normal peak systolic velocity (PSV) ratio (PSV of recanalized middle cerebral artery/PSV of contralateral middle cerebral artery) at 48 hours (OR 0.22, 95% CI 0.15-0.64) and after 1 week (OR 0.11, 95% CI 0.07-0.31) from EVT were independent predictors of good outcome at 3 months. Thrombectomy failure (OR 10.22, 95% CI 1.47-45.53) and pathologic PSV ratio at 1 week from EVT (OR 15.23, 95% CI 4.54-46.72) were associated with a worse 90-day outcome. Patients who subsequently developed postinterventional intracranial hemorrhage (ICH) showed a higher mean PSV ratio (3.5 ± 0.2 vs 2.4 ± 0.1, p < 0.0001) soon after successful recanalization. In multivariate analysis, early PSV ratio was independently associated with postprocedural ICH (OR 8.474, 95% CI 3.066-45.122, p < 0.01]. At 1 week from EVT, 15 of 21 (71.4%) patients with ICH who resumed normal PSV values had a better 90-day outcome (modified Rankin Scale score 0-2: 40% vs 0%). CONCLUSION: Post-EVT ultrasound monitoring of stroke patients might be an effective bedside method for assessing treatment efficacy, shedding light on outcome variability and identifying patients at increased risk of ICH.
OBJECTIVE: To find early hemodynamic predictors of outcome and reperfusion injury in patients with acute ischemic stroke due to anterior circulation large artery occlusion (LAO) after endovascular treatment (EVT). METHODS: Serial transcranial color-coded sonography examinations assessed the vessel status and cerebral hemodynamics of 185 (109 [58.9%] men, mean age 69.5 ± 12.3 years) consecutive patients with acute anterior circulation LAO soon after, at 48 hours after, and 1 week after EVT. RESULTS: Successful recanalization (odds ratio [OR] 0.25, 95% confidence interval [CI] 0.11-0.61) and normal peak systolic velocity (PSV) ratio (PSV of recanalized middle cerebral artery/PSV of contralateral middle cerebral artery) at 48 hours (OR 0.22, 95% CI 0.15-0.64) and after 1 week (OR 0.11, 95% CI 0.07-0.31) from EVT were independent predictors of good outcome at 3 months. Thrombectomy failure (OR 10.22, 95% CI 1.47-45.53) and pathologic PSV ratio at 1 week from EVT (OR 15.23, 95% CI 4.54-46.72) were associated with a worse 90-day outcome. Patients who subsequently developed postinterventional intracranial hemorrhage (ICH) showed a higher mean PSV ratio (3.5 ± 0.2 vs 2.4 ± 0.1, p < 0.0001) soon after successful recanalization. In multivariate analysis, early PSV ratio was independently associated with postprocedural ICH (OR 8.474, 95% CI 3.066-45.122, p < 0.01]. At 1 week from EVT, 15 of 21 (71.4%) patients with ICH who resumed normal PSV values had a better 90-day outcome (modified Rankin Scale score 0-2: 40% vs 0%). CONCLUSION: Post-EVT ultrasound monitoring of stroke patients might be an effective bedside method for assessing treatment efficacy, shedding light on outcome variability and identifying patients at increased risk of ICH.
Authors: Mariana Carvalho Dias; Denis Gabriel; Marlene Saraiva; Daniel Campos; Manuel Requena; Álvaro García-Tornel; Marian Muchada; Sandra Boned; David Rodriguez-Luna; Noelia Rodriguez-Villatoro; Jorge Pagola; Jesus Juega; Matías Deck; Marc Ribo; Alejandro Tomasello; Carlos A Molina; Marta Rubiera Journal: Eur Stroke J Date: 2020-06-11
Authors: C Baracchini; A Pieroni; M Kneihsl; E Azevedo; M Diomedi; L Pascazio; J Wojczal; C Lucas; E Bartels; N M Bornstein; L Csiba; J Valdueza; G Tsivgoulis; B Malojcic Journal: Eur J Neurol Date: 2020-06-18 Impact factor: 6.288