Dynamic transcranial Doppler monitoring predicts intracranial hemorrhage in patients with anterior circulation large vessel occlusion after endovascular treatment

Background Endovascular treatment (EVT) is the most effective treatment for large vessel occlusion (LVO) stroke. Intracranial hemorrhage (ICH) is one of the most common complications after EVT, which is closely associated with poor clinical outcome.Objective In this study, we investigated the value of dynamic transcranial Doppler (TCD) monitoring in predicting ICH in patients with anterior circulation LVO.Methods Based on a prospective cohort, we consecutively collected details of patients with anterior LVO who received successful recanalization after EVT (modified Thrombolysis in Cerebral Infarction score 2b-3) and underwent dynamic TCD monitoring within 24 hours after EVT. TCD was monitored at 30 min, 6 hours, 12 hours and 24 hours after EVT, and the related parameters were measured and calculated, including bilateral peak systolic velocity (PSV), bilateral pulse index (PI), and their different values and ratios at different time points. Logistic regression models were used to detect which TCD parameters were independent predictors of ICH.Results A total of 98 eligible patients were included in this study, including 40 (41%) with ICH. Compared with non-ICH group, multiple logistic regression analysis showed that the difference in value of bilateral PSV at 30 min after EVT (median: -4.5 cm/s vs 0.5 cm/s, P=0.005) was an independent predictor of ICH. A model including this parameter had significantly higher area under the curve values (AUC=0.752) for predicting ICH compared with the baseline model (AUC=0.686) in patients.Conclusion TCD may identify patients at risk of ICH after successful EVT in patients with anterior LVO, and the difference in value of bilateral PSV at 30 min after EVT was an independent predictor of ICH.