Carotid duplex parameters to predict long term outcomes of ischemic stroke patients receiving intra-arterial thrombectomy treatment

• Published in: Medicine (Baltimore) 2019-05, Vol.98 (20), p.e15734-e15734
• Main Authors: Chang, Yu-Jun, Lin, Chih-Ming, Ou, Yang-Hao, Liu, Chi-Kuang, Chen, Wei-Liang, Chang, Shih-Liang
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Brain Ischemia - therapy; Carotid Artery, Internal - surgery; Female; Humans; Infusions, Intra-Arterial; Logistic Models; Male; Middle Aged; Observational Study; ROC Curve; Stroke - therapy; Thrombectomy - methods; Thrombolytic Therapy - methods; Treatment Outcome
• ISSN: 0025-7974; 1536-5964
• DOI: 10.1097/MD.0000000000015734

Early treatment of acute ischemic stroke with intravenous thrombolysis therapy (ITT) followed by intra-arterial thrombectomy (IAT) is a promising new treatment option for improving functional outcomes. Identifying patients who will benefit from this treatment combination is important.A total of 92 acute ischemic stroke patients who received ITT and IAT with a minimum of 1-year follow-up were included in the study. All parameters of clinical and imaging examinations at baseline were examined which parameters were significantly correlated with the 1-year functional outcomes (modified Rankin scale [mRS], National Institute of Health Stroke Scale [NIHSS], and Barthel Index) after stroke. Receiver-operating characteristic (ROC) curves analysis was performed to estimate the diagnostic performance of each significantly related parameter. Youden index was used to determine the optimal threshold value. Multivariate logistic regression model analyses were applied to verify the results of predicting the favorable functional outcomes.Immediate postoperation outcome with modified thrombolysis in cerebral infarction grading showed that total of 62 patients qualified for satisfactory result (2b or 3). In predicting NIHSS improvement, ROC curve analysis showed that a cutoff point of vertebral artery pulsatility index (VA PI)-ipsilateral ≤2.3 yields the best diagnostic performance (area under the ROC curve [AUC] = 0.728); in predicting mRS improvement, VA PI-ipsilateral ≤1.92 and internal carotid artery resistance index (ICA RI)-ipsilateral ≤0.71 yield good diagnostic performance (AUC = 0.697 and 0.672, respectively); and ICA RI-contralateral ≤0.70 or plaque index-ipsilateral ≤2 had better diagnostic accuracy (AUC = 0.764 and 0.689, respectively) than other indices to predict Barthel index improvement. The multivariate analysis also showed that these 5 indices were those more powerful and highly significant favorable functional outcomes predictors.Parameters of pulsatility and resistance index from carotid duplex could be easily accessed and noninvasive. The outcome of ischemic stroke patients receiving ITT followed by IAT can be forecasted by these 2 crucial predictors that hint the patients' functional outcomes as well as guiding first line in-charge clinician in terms of decision making.