Prognosis Evaluation of Acute Ischemic Stroke After Endovascular Treatment: A Synchronous Study of Transcranial Doppler and Quantitative Electroencephalography

Abstract

Background: Patients with acute ischemic stroke (AIS) caused by large vessel occlusions who are successfully recanalized may still have a poor prognosis. Transcranial Doppler (TCD) and quantitative electroencephalography (QEEG) were used to assess cerebral blood flow and metabolism, with the goal of identifying patients with severe neurological deficits and poor prognosis at an early stage. Methods: We prospectively recruited AIS patients with large vessel occlusions with successful recanalization after endovascular treatment and assessed their prognosis at 90 days using the modified Rankin Scale (mRS) score. All patients’ clinical Information, Glasgow Coma Scale (GCS), and National Institute of Health Stroke Scale (NIHSS) scores were recorded. TCD-QEEG was used to evaluate the brain functioning of AIS patients. Results:Thirty-seven patients (63±11.7 years; 24 males) were studied, and 18 patients had a poor prognosis at 90 days which mRS >3. Multivariable analyses showed that TCD indicators ofUPI (pulsatility index of unaffected side) (odds ratio [OR] 1.076, 95% confidence interval [CI] 1.001–1.157, p=0.048), QEEG indicators of pairwise derived brain symmetry index (pdBSI) (OR 3.041, 95%CI 1.040–8.897, p=0.042), and NIHSS score (OR 1.638, 95%CI 1.071–2.504, p=0.023) were independent predictors of clinical outcomes. The area under the ROC curve for the model combining UPI, pdBSI, and NIHSS scores was 0.980, demonstrating superior predictive accuracy than any single variable. Conclusions: The combination of TCD, QEEG, and NIHSS scores demonstrated the best prognostic assessment accuracy by assessing cerebral blood flow, metabolism, and neurological function in patients with AIS after revascularization.