Assessment Of Cerebral Hemodynamic Changes In Acute Ischemic Stroke Patients After Endovascular Treatment By Transcranial Doppler And Its Effect On Clinical Outcome

Objective: Cerebral blood flow in acute ischemic stroke patients with successful endovascular treatment due to anterior circulation large artery occlusion was evaluated by transcranial Doppler(TCD),and the relationship between cerebral hemodynamics at first 3 day with intracranial hemorrhage and clinical outcomes at 3 months was explored.Methods: A total of 82 patients with anterior circulation large artery occlusions which received endovascular treatment and achieved effective recanalization(m TICI 2b-3)in the Department of Neurology at the First Affiliated Hospital of Jinan University from February 27,2019 to November 30,2020 were enrolled in this study.TCD examination was performed three consecutive day s after operation,and the blood flow direction,blood flow velo city and PI values of intracranial and extracranial cerebrovascular vessels were recorded.The ratio of peak systolic velocity(PSV of recanalized MCA/PSV of contral ateral MCA)and the ratio of mean flow velocity were calculated.C erebral ischemia thrombol ysis(TIBI)classification was evaluated by blood flow velocity,PI value,blood flow spectrum.The patients were followed up by telephone or return to the hospital 3 months after endovascular treatment.The cerebral hemodynamics after endovascular treatment were observed in the first three days,and the influencing factors of intracranial hemorrhage were analyzed.Cerebral blood flow was evaluated by TIBI classification,and its relationship with prognosis was analyzed.Result: In patients with intracranial hemorrhage after endovascular treatment,the peak systolic blood velocity and average flow velocity of the middle cerebral artery on the affected side were higher than contralateral MCA at the first three days after operation,and the difference was statistically significant(p < 0.05,respectively).The difference of ratio of the peak systolic flow velocity and ratio of the average flow velocity between bleeding group and non-bleeding group on the first postoperative day was statistically significant(1.33±0.31 vs 1.09±0.35,p=0.004;1.35±0.34 vs 1.12±0.38,p=0.011).Patients with poor outome were more likely to develop to cerebral blood flow deterioration(35.3% vs 6.1%,p=0.024).Multivariate analysis suggested that higher ASPECTS score(OR8.76,95% CI 2.03-37.81,p= 0.004),postoperative intracranial hemorrhage(OR 5.03,95% CI 1.35-18.79,p = 0.016)and cerebral blood flow did not return to normal on the third day after operation(OR 6.37,95% CI1.9321.06,p = 0.002)were independent predictors of poor prognosis after3 months;Cerebral blood flow ret urned to normal on the first day after operation(OR 0.11,95% CI 0.03-0.37,p= 0.000)was an independent predictor of good prognosis 3 months after operation.Conclusions: In patients with anterior circulation large vessel occlusion with successful recanalization,the cerebral blood flow velocity on the side of recanalization was more than 30% higher than t hat on the opposite side after operation,which was closely related to intracranial hemorrhage.TIBI grading system based on TCD i s available in evaluating the postoperative cerebral blood flow,deterioration of cerebral blood flow is associated with poor prognosis,patients with TIBI grade 5 in the early period are associated with good prognosis,while those with cerebral blood flow s till not return to normal on the third day after surgery are associated with poor prognosis.