Early Cerebrovascular Ultrasonography as a Predictor of Hemorrhagic Transformation After Thrombectomy.
OBJECTIVES
To determine the predictive value of early transcranial color-coded sonography (TCCS) for intracranial hemorrhage (ICH) in patients with large artery occlusion (LAO) stroke of carotid circulation, who were submitted to endovascular therapy (EVT) with successful reperfusion.


MATERIALS AND METHODS
Retrospective study evaluating a cohort of consecutive stroke patients with LAO of the carotid circulation that were recanalyzed with EVT. We measured angle-corrected peak systolic velocities, end-diastolic velocities and mean flow velocities (PSV, EDV and MFV) of the symptomatic and asymptomatic middle cerebral artery (MCA). The ratio between MFV of the symptomatic MCA and MFV of the asymptomatic MCA (MCA-Ra) was calculated. Parenchymal hematoma in the 24 hours control CT was considered as ICH. Univariate associations and multivariate analyses were used to identify early independent predictors for ICH among TCCS findings.


RESULTS
We included 234 patients, mean age 72.5 (SD 12.6) years, 52.1% male. The mean time between recanalization and TCCS was 12.3 hours (range 3-22). Patients who developed postinterventional ICH showed a higher MCA-Ra (1.02 ± 0.26 vs 1.16 ± 0,21, p = 0.036). In multivariate analysis, only higher MCA-Ra remained independently associated with postinterventional ICH (OR: 6.778, 95%CI: 1.152-39.892, p = 0.034). A value of MCA-Ra ≥ 1,05 was associated with ICH, showing a sensitivity of 81.3% and a specificity of 65.9%; the AUC based of the ROC analysis was 0.688 (95% CI 0.570-0.806).


CONCLUSION
TCCS performed within the first 24 hours after stroke onset can help to predict hemorrhagic transformation in patients with LAO.
['Cruz|L|L|', 'Silva|A|A|', 'Lopes|J|J|', 'Damas|D|D|', 'Lourenço|J|J|', 'Costa|A|A|', 'Silva|F|F|', 'Sousa|J|J|', 'Galego|O|O|', 'Nunes|C|C|', 'Veiga|R|R|', 'Machado|C|C|', 'Rodrigues|B|B|', 'Cecilia|C|C|', 'Almendra|L|L|', 'Bras|A|A|', 'Santo|G|G|', 'Machado|E|E|', 'Sargento-Freitas|J|J|']
D000368:Aged D000369:Aged, 80 and over D001783:Blood Flow Velocity D002560:Cerebrovascular Circulation D057510:Endovascular Procedures D005260:Female D006801:Humans D020244:Infarction, Middle Cerebral Artery D020300:Intracranial Hemorrhages D000083242:Ischemic Stroke D008297:Male D008875:Middle Aged D011237:Predictive Value of Tests D012042:Registries D015203:Reproducibility of Results D012189:Retrospective Studies D018570:Risk Assessment D012307:Risk Factors D017131:Thrombectomy D013997:Time Factors D016896:Treatment Outcome D018615:Ultrasonography, Doppler, Color D017585:Ultrasonography, Doppler, Transcranial
Ultrasonography Thrombectomy Stroke Middle Cerebral Artery Ischaemic stroke Reperfusion Injury