• Junya Aoki, Larry N Raber, Irene L Katzan, Muhammad Shazam Hussain, Ferdinand K Hui, and Ken Uchino.
• Cerebrovascular Center, Neurological Institute, Cleveland Clinic, OH, USA. Electronic address: aojyun@med.kawasaki-m.ac.jp.
• J. Neurol. Sci. 2013 Nov 15; 334 (1-2): 26-9.

Background And PurposeSome 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.MethodsAcute 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.ResultsAmong 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).ConclusionFollow-up TCD examination after IA intervention in acute stroke patients may predict poor outcome beyond angiographic residual TIMI flow.© 2013 Elsevier B.V. All rights reserved.

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