Abstract TP206: Transcranial Doppler Markers of Increased Microvascular Resistance After Successful Endovascular Revascularization Are Associated With Larger Infarct Volumes

Abstract

Background: Markers of increased microvascular resistance on Transcranial Doppler (TCD) obtained shortly after successful endovascular therapy (EVT) in patients with large-vessel occlusion (LVO) stroke have been associated with unfavorable outcomes. We aim to investigate whether post-EVT pulsatility index (PI) correlates with final infarct volume in this population. Methods: We analyzed consecutive anterior circulation LVO patients who underwent successful EVT (mTICI 2c-3) from 2012 to 2022. Patients with available TCD within 48 hours of EVT and brain MRI during admission were included. The TCD-derived PI was obtained from the ipsilateral middle cerebral artery. The ABC/2 method was used to estimate the final infarct volume in mL on MRI diffusion-weighted imaging. Pearson correlation and adjusted linear regression analysis were used to investigate the relationship between post-EVT PI and final infarct volume. Linear regression analysis was adjusted for age, NIHSS, and ASPECTS. Results: Out of 155 LVO patients with successful EVT during the study period, 40 were included in the analysis (mean age, 69 ± 16.7 years; 57% female; median NIHSS 15 (IQR 10); and median ASPECTS 9 (IQR, 2)). The median time from EVT to TCD and EVT to MRI was 21 hours (IQR, 17 hours) and 41 hours (IQR, 33 hours), respectively. Post EVT PI displayed a positive moderate correlation with final infarct volume (r=0.39, p<0.01; Figure 1). Larger PI values were independently associated with larger infarct volumes (β = 42.2 mL, 95% CI 37.0 - 47.5 mL). Conclusion: TCD-derived PI shortly after EVT correlated with final infarct volume in successfully revascularized LVO patients. TCD may serve as a valuable tool to identify those at risk for infarct progression and reveal potential therapeutic targets to maximize EVT benefit in this population.