Rapid Evaluation of Large Vessel Occlusion for Mechanical Thrombectomy Using Carotid Duplex Ultrasound

Objectives This study clarified the usefulness of carotid duplex ultrasound (CDU) in evaluating large vessel occlusion (LVO) in patients with acute stroke planned to be treated with mechanical thrombectomy (MT). Methods This study was single-center, prospective, observational trial. If the ratio of...

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Bibliographic Details
Published in:Internal Medicine 2023/03/01, Vol.62(5), pp.703-710
Main Authors: Itabashi, Ryo, Shigehatake, Yuya, Saito, Takuya, Endo, Kaoru, Fukuma, Kazuki, Kobayashi, Yuya, Kawabata, Yuichi, Yazawa, Yukako, Matsumoto, Yasushi, Inoue, Manabu, Koga, Masatoshi
Format: Article
Language:English
Subjects:
Angiography
Carotid artery
carotid duplex ultrasound
Cerebral blood flow
Humans
Internal medicine
Ischemia
large vessel occlusion
Magnetic Resonance Angiography
mechanical thrombectomy
Original
Prospective Studies
Stroke
Thrombectomy
Ultrasonic imaging
Ultrasonography, Carotid Arteries
Ultrasound
United States
Veins & arteries
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Summary:Objectives This study clarified the usefulness of carotid duplex ultrasound (CDU) in evaluating large vessel occlusion (LVO) in patients with acute stroke planned to be treated with mechanical thrombectomy (MT). Methods This study was single-center, prospective, observational trial. If the ratio of end-diastolic velocity in the common carotid arteries was ≥1.4, or diastolic flow in the affected internal carotid artery (ICA) was absent on CDU, patients were immediately transferred to the angio-suite without additional cerebrovascular imaging. Clinical parameters, including time metrics and outcomes, were evaluated in participants. Patients We enrolled stroke patients with a National Institutes of Health Stroke Scale score ≥6 and Alberta Stroke Program Early CT score ≥6 in whom MT could be initiated within 6 hours of the stroke onset. Results Among 140 patients screened during the study period, 48 were ultimately enrolled. Twenty-seven patients were diagnosed with LVO by CDU alone. CDU offered 83% sensitivity and 82% specificity for identifying the occlusion of the ICA or M1 segment of the middle cerebral artery. Among the 29 total patients treated with MT, 20 (67%) showed a modified Rankin Scale score ≤2 at 90 days. The door-to-puncture time was significantly shorter in patients evaluated by CDU alone (34 minutes) than in those evaluated by magnetic resonance angiography after CDU (47.5 minutes, p
ISSN:0918-2918
1349-7235
DOI:10.2169/internalmedicine.0029-22