Carotid duplex parameters to predict long term outcomes of ischemic stroke patients receiving intra-arterial thrombectomy treatment

Chang, Yu-Jun; Lin, Chih‐Ming; Ou, Yang-Hao; Liu, Chi-Kuang; Chen, Wei‐Liang; Chang, Su-Wei

doi:10.1097/md.0000000000015734

Cited by 5 publications

(6 citation statements)

References 21 publications

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“…As far as pre-intervention carotid doppler parameters, the higher the ipsilateral vertebral artery resistance index, which indicates compromised blood flow starting at the inlet of posterior circulation, therefore in the event of acute ischemic stroke of the anterior circulation, there are less available blood flow to rescue the ischemic brain cells and leading to higher risk of functional disability in such selected patients. [9,10] As most of the collected patients more or less had the tandem stenosis both/or intra-cranially, the presence of the patent of the posterior vasculature stands as an important compensatory collateral flows that can minimize the stroke severity or post bridging therapy induced cerebral hemorrhagic or ischemic events Interestingly, the current study showed that the higher the value of contralateral external carotid artery resistance index leads to a better functional outcome in ischemic stroke patients. We hypothesize that impaired contralateral blood flow re-directs blood flow toward the opposite side, which is the ischemic hemisphere, that is sufficient to prevent the progression of the disease and is meaningful in predicting the long-term functional outcome in patients.…”

Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

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The age factor influencing long-term physical functionality in stroke patients undergoing intra-arterial thrombectomy treatment

et al. 2022

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The treatment of acute ischemic stroke is heavily time-dependent, and even though, with the most efficient treatment, the longterm functional outcome is still highly variable. In this current study, the authors selected acute ischemic stroke patients who were qualified for intravenous thrombolysis with recombinant tissue plasminogen activator and followed by intra-arterial thrombectomy. With primary outcome defined by the functional level in a 1-year follow-up, we hypothesize that patients with older age are at a disadvantage in post-stroke recovery. However, an age-threshold should be determined to help clinicians in selection of patients to undergo such therapy. This is a retrospective chart review study that include 92 stroke patients in Changhua Christian hospital with a total of 68 evaluation indexes recorded. The current study utilized the forward stepwise regression model whose Adj-R 2 and P value in search of important variables for outcome prediction. The chngpt package in R indicated the threshold point of the age factor directing the better future functionality of the stroke patients. Datasets revealed the threshold of the age set at 79 the most appropriate. Admission Barthel Index, Age, ipsilateral internal carotid artery resistance index (ICA RI), ipsilateral vertebral artery (VA) PI, contralateral middle cerebral artery (MCA) stenosis, contralateral external carotid artery (ECA) RI, and in-hospital pneumonia are the significant predicting variables. The higher the age, in-hospital pneumonia, contralateral MCA stenosis, ipsilateral ICA RI and ipsilateral VA PI, the less likely patient to recover from functional deficits as the result of acute ischemic stroke; the higher the value of contralateral ECA RI and admission Barthel Index, the better chance to full functional recovery at 1-year follow up. Parameters of pre-intervention datasets could provide important information to aid first-line clinicians in decision making. Especially, in patients whose age is above 79 receives diminish return in the benefit to undergo such intervention and should be considered seriously by both the patients and the physicians.

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Section: Discussionmentioning

confidence: 60%

Section: Discussionmentioning

confidence: 99%

The age factor influencing long-term physical functionality in stroke patients undergoing intra-arterial thrombectomy treatment

et al. 2022

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“…Powers et al [10] and Yu-Jun and colleagues [11] found that parameters of PI and RI were predictors of outcome of ischemic stroke patients and may assist in predicting the outcomes of patients who have undergone thrombolytic procedures.…”

Section: Discussionmentioning

confidence: 99%

Duplex ultrasonography as prognostic tool of acute ischemic stroke patients

El-khatib

Ahwal

2021

Egypt J Neurol Psychiatry Neurosurg

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Background Cerebral stroke is a major source of mortality and morbidity. Duplex ultrasonography is used to evaluate carotid and cerebral arteries. The objectives of this work are to study the correlation between carotid duplex parameters with risk factors of ischemic stroke and evaluate duplex parameter as prognostic tool of ischemic stroke. Methods The study was conducted on 100 patients presented by acute ischemic stroke submitted to history taking, medical, and neurological examination. Neurological deficit was assessed by National Institute of Health Stroke Scale (NIHSS); the functional state of the patients was assessed by modified Rankin scale (mRS). Brain CT and/or MRI, routine laboratory investigations, extracranial, and transcranial duplex (TCD) were done. Results The end diastolic velocities (EDVs) and peak systolic velocities (PSVs) of common carotid arteries (CCA) were significantly decreased in smokers and hypertensive (P<0.05). Smoking and hypertension were positively correlated with resistive index (RI). In 80 patients, PSV in the symptomatic middle cerebral artery (MCA) did not exceed 70 cm/s within averaged 50.7 ± 4.6 cm/s. EDV was 12.0 ± 3.0 cm/s, RI was 0.78 ± 0.05, and pulsativity index (PI) was 1.61 ± 0.09. There was significant difference in all hemodynamic parameters in comparison with the asymptomatic side. Conclusion Patients who have risk factors of stroke should be evaluated with duplex ultrasonography. Duplex parameters can give informative data about prognosis and outcome.

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“…Likewise, carotid Doppler is a noninvasive simple, accurate, and reproducible method to assess carotid arteries for evaluating blood flow. [ 11 , 12 ] It measures peak systolic velocity (PSV), end diastolic velocity (EDV), mean flow velocity (MFV), and peak diastolic velocity which measure the resistive index (RI) and pulsatility index (PI), the most practical parameters for assessing hemodynamic status of the common carotid artery, internal carotid artery (ICA), extracranial carotid artery, vertebral artery, and ophthalmic artery. [ 13 ] PI assesses vascular resistance and is considered a marker of small vessel disease and microangiopathic changes in the brain, [ 14 , 15 ] whereas RI relates to the vessel wall elasticity.…”

Section: Introductionmentioning

confidence: 99%

“…[ 17 ] Assessment of PSV, PI, and RI can provide important information for making therapeutic decisions and help as a prognostic tool in predicting functional outcomes in patients of ischemic stroke or after carotid interventions. [ 11 , 18 - 20 ] These parameters are related to the NIHSS in a direct relation and can predict the LOS in patients with acute ischemic stroke and hence predict the functional and prognostic outcome in such patients. The present study was done to compare NIHSS, RI, and PI of both ipsilateral and contralateral ICA with the type of stroke (ischemic or hemorrhagic) and duration of hospital stay.…”

Section: Introductionmentioning

confidence: 99%

Sequential carotid Doppler study in acute stroke and its clinical correlation: A prospective study

Karn,

Narayan,

Qavi

et al. 2023

JNRP

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Objectives: Resistive index (RI) and pulsatility index (PI) assessed on carotid Doppler assess the hemodynamic status of cranial vasculature. They are related to the severity of stroke and help determine the overall outcome. This study was done to compare the hospital stay and stroke severity with RI and PI of both internal carotid arteries. Materials and Methods: Patients >18 years of age presenting within 48 h of anterior circulation stroke (either ischemic or hemorrhagic) were included. They were divided into two groups based on their length of stay (LOS). They were assessed clinically on days 1, 3, and 5, and underwent a carotid Doppler study on the same days. The Doppler parameters were correlated with the LOS and stroke severity for possible associations. Results: One hundred and one patients were included. Forty-seven patients had a favorable outcome based on LOS. In this group, significant decrease in RI and PI scores was seen from days 1 to 3. In patients with unfavorable outcome, there was a significant increase in PI on days 1–3 and days 1–5. The National Institutes of Health Stroke Scale decreased significantly from days 1 to 5 in favorable group Conclusion: For those with an unfavorable outcome and prolonged LOS, PI continues to increase suggesting a failure of autoregulation. Carotid Doppler can be a simple bedside tool to predict outcome in patients with acute stroke.

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Carotid duplex parameters to predict long term outcomes of ischemic stroke patients receiving intra-arterial thrombectomy treatment

Abstract: Supplemental Digital Content is available in the text

Cited by 5 publications

References 21 publications

The age factor influencing long-term physical functionality in stroke patients undergoing intra-arterial thrombectomy treatment

The age factor influencing long-term physical functionality in stroke patients undergoing intra-arterial thrombectomy treatment

Duplex ultrasonography as prognostic tool of acute ischemic stroke patients

Sequential carotid Doppler study in acute stroke and its clinical correlation: A prospective study

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