Abstract WP120: Can Early Transcranial Doppler Ultrasound Predict Early Neurological Deterioration And Risk Of Hemorrhagic Transformation After Endovascular Treatment?

Background: Recent advances in endovascular therapy (EVT) have led to a significant improvement in functional outcomes of patients with stroke. However, early neurological deterioration (END) after EVT has still remained a concerning issue. Reasons for END include reocclusion, hyperperfusion after recanalization, and hemorrhagic transformation. The current study was designed to assess the feasibility of early transcranial Doppler (TCD) after EVT, to identify association between TCD findings and END. Methods: This is a pilot study to assess the feasibility of TCD prior and early (within 60 minutes) after EVT. For all selected arteries, we measured peak systolic velocity, end diastolic velocity, mean flow velocity and pulsatility index. Patients were followed for three months after the intervention and disability was measured using modified Rankin scale (mRS). We examined the possible association between active leptomeningeal collateral flow after EVT and END. Results: Between October 16, 2020, and March 28, 2021, we recruited 20 acute ischemic stroke patients with large vessel occlusion who underwent EVT. Five patients were excluded because of a poor temporal window; two had an unsuccessful intervention. Four patients had END and all of them had active leptomeningeal flow with elevated blood pressure after EVT. In cases without END, we did not observe any flow diversion or active leptomeningeal collateral after EVT.In those without significant post-stroke disability (mRS<2), we did not observe any active leptomeningeal flow or flow diversion with blood pressure of ≤ 155/85. Most patients with post-stroke disability (mRS ≥ 2) had either flow diversion or active leptomeningeal flow in the presence of blood pressure ≥ 170/93. Hyperemia was associated with hemorrhagic transformation, particularly in the presence of elevated blood pressure. All cases with symptomatic hemorrhagic transformation had hyperemia. Conclusion: TCD is a feasible approach early after EVT. It has clinical implications in identifying those with END and risk for sICH. Early TCD after EVT may provide personalized BP management based on individualized cerebral flow and the presence of active collateral flow after EVT. Studies with larger sample size are warranted.