Post-intervention TCD examination may be useful to predict outcome in acute ischemic stroke patients with successful intra-arterial intervention

Junya Aoki, Larry N. Raber, Irene L. Katzan, Muhammad Shazam Hussain, Ferdinand Hui, Ken Uchino

Research output: Contribution to journalArticle

Abstract

Background and purpose 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). Conclusion Follow-up TCD examination after IA intervention in acute stroke patients may predict poor outcome beyond angiographic residual TIMI flow.

Original languageEnglish (US)
Pages (from-to)26-29
Number of pages4
JournalJournal of the Neurological Sciences
Volume334
Issue number1-2
DOIs
StatePublished - Nov 15 2013
Externally publishedYes

Fingerprint

Middle Cerebral Artery
Stroke
Myocardial Infarction
Decompressive Craniectomy
Alberta
Middle Cerebral Artery Infarction
National Institutes of Health (U.S.)
Internal Carotid Artery
Brain Ischemia
Coronary Artery Disease
Arteries
Odds Ratio
Tomography
Confidence Intervals

Keywords

  • Acute ischemic stroke
  • Intra-arterial intervention
  • Poor outcome
  • Pulsatility index
  • Recanalization
  • Transcranial Doppler

ASJC Scopus subject areas

  • Clinical Neurology
  • Neurology

Cite this

Post-intervention TCD examination may be useful to predict outcome in acute ischemic stroke patients with successful intra-arterial intervention. / Aoki, Junya; Raber, Larry N.; Katzan, Irene L.; Hussain, Muhammad Shazam; Hui, Ferdinand; Uchino, Ken.

In: Journal of the Neurological Sciences, Vol. 334, No. 1-2, 15.11.2013, p. 26-29.

Research output: Contribution to journalArticle

Aoki, Junya ; Raber, Larry N. ; Katzan, Irene L. ; Hussain, Muhammad Shazam ; Hui, Ferdinand ; Uchino, Ken. / Post-intervention TCD examination may be useful to predict outcome in acute ischemic stroke patients with successful intra-arterial intervention. In: Journal of the Neurological Sciences. 2013 ; Vol. 334, No. 1-2. pp. 26-29.
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abstract = "Background and purpose 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). Conclusion Follow-up TCD examination after IA intervention in acute stroke patients may predict poor outcome beyond angiographic residual TIMI flow.",
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T1 - Post-intervention TCD examination may be useful to predict outcome in acute ischemic stroke patients with successful intra-arterial intervention

AU - Aoki, Junya

AU - Raber, Larry N.

AU - Katzan, Irene L.

AU - Hussain, Muhammad Shazam

AU - Hui, Ferdinand

AU - Uchino, Ken

PY - 2013/11/15

Y1 - 2013/11/15

N2 - Background and purpose 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). Conclusion Follow-up TCD examination after IA intervention in acute stroke patients may predict poor outcome beyond angiographic residual TIMI flow.

AB - Background and purpose 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). Conclusion Follow-up TCD examination after IA intervention in acute stroke patients may predict poor outcome beyond angiographic residual TIMI flow.

KW - Acute ischemic stroke

KW - Intra-arterial intervention

KW - Poor outcome

KW - Pulsatility index

KW - Recanalization

KW - Transcranial Doppler

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