The Prognostic Value of Reversed Ophthalmic Artery Flow Direction in Acute Stroke Patients with Ipsilateral Extra Cranial Carotid Artery Stenosis

Abstract

Abstract Background According to the World Health Organization, about 15 million people suffer a stroke each year with roughly one-third resulting in death and another one-third sustaining severe permanent disability. Even in developed nations, stroke is the third leading cause of death. It also costs billions of dollars through lost productivity, premature mortality and care for stroke survivors. The evaluation of hemodynamics, autoregulation and collaterals is cardinal for clinical outcomes. The Use of Transcranial Doppler (TCD) in detecting reversal of blood flow direction especially in anterior communicating and ophthalmic arteries, and flow diversion between anterior and posterior circulation provide critical information on ipsilateral collateral status. The impact of collateral status has been correlated with clinical symptoms, reperfusion success and functional outcome at discharge. A rationale now exists for imaging assessment to guide physicians in the precision medicine of stroke care. Aim of the work This study is performed for evaluation of hemodynamics in ophthalmic artery as a collateral and its value as a prognostic factor in patients with carotid artery extra cranial stenosis in acute cerebrovascular stroke. Patients and Methods 30 patients with acute cerebrovascular stroke were recruited in this cross-sectional study admitted in stroke unit at the department of neurology of Ain Shams University hospitals. Results There was a statistically significant difference between the Modified Rankin Scale on discharge and follow up after 3 months in patients suffering from acute cerebrovascular stroke with ipsilateral severe extra cranial carotid artery stenosis and reversed ophthalmic artery flow direction (p value =0.042), compared to the group with direct ophthalmic artery flow direction where the (p = 0.086). Conclusion Transcranial Duplex is a diagnostic tool that provides a non-invasive, real time, safe technique information data on intracerebral hemodynamics. It was used in this study to detect that there is a significant difference in functional outcome between patients with forward and reversed ophthalmic artery flow direction with acute cerebrovascular stroke and ipsilateral extracranial carotid artery stenosis.