Khan Adnan, Saqqur Maher, Shuaib Ashfaq, Khan Khurshid, Sharma Vijay K, Brunser Alejandro, Eggers Jürgen, Mikulik Robert, Katsanos Aristeidis H, Sergentanis Theodore N, Vadikolias Konstantinos, Rubiera Marta, Shahripour Reza Bavarsad, Nguyen Huy Thang, Martínez-Sánchez Patricia, Safouris Apostolos, Heliopoulos Ioannis, Salam Abdul, Derksen Carol, Voumvourakis Konstantinos, Psaltopoulou Theodora, Alexandrov Anne W, Alexandrov Andrei V, Tsivgoulis Georgios
Faculty of Allied Health Sciences, Khyber Medical University, Peshawar, Pakistan.
Trillium Health Partners, Mississauga Hospital, Mississauga, Ontario, Canada.
J Neuroimaging. 2024 Jul-Aug;34(4):430-437. doi: 10.1111/jon.13207. Epub 2024 May 25.
Transcranial Doppler (TCD) identifies acute stroke patients with arterial occlusion where treatment may not effectively open the blocked vessel. This study aimed to examine the clinical utility and prognostic value of TCD flow findings in patients enrolled in a multicenter prospective study (CLOTBUST-PRO).
Patients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA-to-contralateral MCA MFV [aMCA/cMCA MFV ratio]).
A total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty-eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24-hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of <.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO.
TCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra-arterial lysis protocols.
经颅多普勒（TCD）可识别出存在动脉闭塞的急性脑卒中患者，而这些患者的阻塞血管可能无法通过治疗有效打通。本研究旨在探讨 TCD 血流检查在接受多中心前瞻性研究（CLOTBUST-PRO）的患者中的临床应用价值和预后价值。
本分析纳入了计算机断层血管造影（CTA）显示颅内闭塞且在静脉溶栓前接受紧急 TCD 评估的患者。采用大脑中动脉（MCA）双侧深度的倒数比值（患侧 MCA 与对侧 MCA 平均血流速度的比值[aMCA/cMCA 平均血流速度比值]）评估 TCD 结果。
本研究共纳入 222 例 CTA 显示颅内闭塞的患者（平均年龄：64 ± 14 岁，62%为男性）。88 例患者存在 M1MCA 闭塞；基线美国国立卫生研究院卒中量表（NIHSS）评分为 16 分，24 小时平均 NIHSS 评分为 10 分。aMCA/cMCA 平均血流速度比值＜.6 对识别大血管闭塞（LVO）（包括 M1MCA、颈内动脉终末段或串联 ICA/MCA）的敏感度为 99%，特异度为 16%，阳性预测值（PPV）为 60%，阴性预测值（NPV）为 94%。与无脑血流（NIHSS 评分 0 级）相比，有溶栓反应（NIHSS 评分≥1 级）的患者发生 LVO 的敏感度为 17.1%，特异度为 86.9%，PPV 为 62%，NPV 为 46%。
TCD 是评估急性缺血性脑卒中患者动脉循环的一种有价值的方法，具有作为静脉/动脉内溶栓方案筛选工具的显著潜力。
