Carlos Gómez-Escalonilla1, Patricia Simal2, Hector García-Moreno3, Talía Liaño Sánchez4, Diego Mayo Canalejo5, María Romeral Jiménez6, Lorenzo Silva Hernández7, Daniel Toledo Alfocea8, Manuel Moreu9, Carlos Pérez-García9, Santiago Rosati9, Jose Antonio Egido2. 1. Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, Madrid, 28040, Spain. Electronic address: carlosignacio.gomezescalonilla@salud.madrid.org. 2. Stroke Unit, Neurology Department, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, Madrid, 28040, Spain. 3. Department of Clinical and Movement Neurosciences, University College London, UCL Queen Square Institute of Neurology, Queen Square, London, WC1N 3BG, United Kingdom. Electronic address: h.garcia-moreno@ucl.ac.uk. 4. Neurology, Complejo Hospitalario Ruber Juan Bravo, Calle Juan Bravo 39, Madrid, 28006, Spain. 5. Neurology, Hospital Universitario de Móstoles, Rio Jucar S/N, Móstoles, 28935, Spain. 6. Neurology, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, Madrid, 28040, Spain. 7. Neurology, Hospital Universitario Puerta de Hierro, C/Manuel de Falla 2, Majadahonda, 28222, Spain. Electronic address: l.silva@ucm.es. 8. Neurology, Hospital Universitario 12 de Octubre, Av de Córdoba, s/n, Madrid, 28041, Spain. 9. Interventional Neuroradiology, Hospital Clínico San Carlos, Calle Profesor Martín Lagos s/n, Madrid, 28040, Spain.
Abstract
OBJECTIVES: The aim of the study is to analyze the hemodynamic changes in the middle cerebral artery (MCA) after endovascular revascularization in acute ischemic stroke (AIS) due to large vessel occlusion and its association with the infarct volume size in the control head CT. MATERIALS AND METHODS: Prospective study of patients with AIS due to internal carotid artery terminus or M1 segment of the MCA occlusion, who underwent endovascular treatment with a final TICI 2b-3 score, without concomitant stenosis ≥50% in both cervical carotid arteries. Transcranial Doppler ultrasound (TCD) of both MCAs was carried out at 6 h after the endovascular procedure. Mean flow velocities (MFV) after arterial reperfusion and its association with the infarct volume size in 24-36 h control head CT were determined. RESULTS: 91 patients (51 women) were included with a median age of 78 years and National institute of Health Stroke Scale of 18. The MCA was occluded in 76.92%, and intravenous thrombolysis was administered in 40.7%. The incidence of symptomatic intracranial hemorrhage was 5.5%. At three months, mortality was 19.8% and a 52.7% of patients achieved functional independence (modified Rankin Scale 0-2). After a multivariable logistic regression analysis, an increase in the MFV greater than 50% at 6 h in the treated MCA compared to contralateral MCA, was an independent predictor of large infarct volume in the control head CT with an OR 9.615 (95%CI: 1.908-47.620), p=0.006 CONCLUSIONS: Increased MFV assessed by TCD examination following endovascular recanalization is independently associated with larger infarct volume.
OBJECTIVES: The aim of the study is to analyze the hemodynamic changes in the middle cerebral artery (MCA) after endovascular revascularization in acute ischemic stroke (AIS) due to large vessel occlusion and its association with the infarct volume size in the control head CT. MATERIALS AND METHODS: Prospective study of patients with AIS due to internal carotid artery terminus or M1 segment of the MCA occlusion, who underwent endovascular treatment with a final TICI 2b-3 score, without concomitant stenosis ≥50% in both cervical carotid arteries. Transcranial Doppler ultrasound (TCD) of both MCAs was carried out at 6 h after the endovascular procedure. Mean flow velocities (MFV) after arterial reperfusion and its association with the infarct volume size in 24-36 h control head CT were determined. RESULTS: 91 patients (51 women) were included with a median age of 78 years and National institute of Health Stroke Scale of 18. The MCA was occluded in 76.92%, and intravenous thrombolysis was administered in 40.7%. The incidence of symptomatic intracranial hemorrhage was 5.5%. At three months, mortality was 19.8% and a 52.7% of patients achieved functional independence (modified Rankin Scale 0-2). After a multivariable logistic regression analysis, an increase in the MFV greater than 50% at 6 h in the treated MCA compared to contralateral MCA, was an independent predictor of large infarct volume in the control head CT with an OR 9.615 (95%CI: 1.908-47.620), p=0.006 CONCLUSIONS: Increased MFV assessed by TCD examination following endovascular recanalization is independently associated with larger infarct volume.