Reliability and sensitivity of transcranial Doppler in the prediction of recurrence in ischemic stroke

Abstract

ObjectivesThis study was designed to evaluate the role of serial transcranial Doppler (TCD) examinations in the prediction of early recurrence in acute cerebral ischemia (ACI).BackgroundIn patients with ACI, either transient ischemic attack or acute ischemic stroke, the risk of early recurrence is significant. TCD enables the examination of hemodynamic patterns of intracranial circulation blood flow. After transient ischemic attack or acute ischemic stroke, developing cerebral flow hemodynamics is related to the stroke outcome.Materials and methodsA prospective trial was performed on 60 patients with the first ever or second-time ACI affecting the anterior circulation territory. A diagnostic work up including full clinical examination, routine laboratory tests, brain computed tomography, and TCD examination were performed to evaluate the risk factors of recurrence. Patients were followed up by clinical and TCD examination for 90 days after ischemia (days 2, 7, 30, and 90) to detect clinical and hemodynamic evidences of correlated with early recurrence.ResultsPatients were divided into two groups [group A with early recurrence (n = 12) and group B without early recurrence (n = 48)]. Diabetes mellitus, atrial fibrillation, and a history of cerebrovascular ischemia were found to be significantly associated with early recurrence of ischemia (P < 0.05). Initial TCD parameters showed that about 75% of the study patients had an abnormally increased mean arterial flow velocity (MFV) of the intracranial artery supplying the affected vascular territory. Group A patients tended to have a higher MFV (M = 77 ± 11.7) than group B patients (M = 66.47 ± 15.3) with significant effect (P < 0.05). Microembolic signals were detected in 10/12 patients (83%) with early recurrence, showing a significant relationship (P < 0.001).ConclusionOur results indicate that TCD parameters of intracranial hemodynamics, especially increasing MFV of the affected intracranial arteries and detection of microembolic signals, are of predictive value in risk stratification of early recurrence in patients with ACI.