Abstract：
OBJECTIVE: Transcranial Doppler (TCD) identifies acute stroke patients with arterial occlusion where treatment may not effectively open the blocked vessel. This study aimed to examine the clinical utility and prognostic value of TCD flow findings in patients enrolled in a multicenter prospective study (CLOTBUST-PRO).
METHODS: Patients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA-to-contralateral MCA MFV [aMCA/cMCA MFV ratio]).
RESULTS: A total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty-eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24-hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of <.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO.
CONCLUSIONS: TCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra-arterial lysis protocols.
METHODS: Patients enrolled with intracranial occlusion on computed tomography angiography (CTA) who underwent urgent TCD evaluation before intravenous thrombolysis was included in this analysis. TCD findings were assessed using the mean flow velocity (MFV) ratio, comparing the reciprocal ratios of the middle cerebral artery (MCA) depths bilaterally (affected MCA-to-contralateral MCA MFV [aMCA/cMCA MFV ratio]).
RESULTS: A total of 222 patients with intracranial occlusion on CTA were included in the study (mean age: 64 ± 14 years, 62% men). Eighty-eight patients had M1 MCA occlusions; baseline mean National Institutes of Health Stroke Scale (NIHSS) score was 16, and a 24-hour mean NIHSS score was 10 points. An aMCA/cMCA MFV ratio of <.6 had a sensitivity of 99%, specificity of 16%, positive predictive value (PV) of 60%, and negative PV of 94% for identifying large vessel occlusion (LVO) including M1 MCA, terminal internal carotid artery, or tandem ICA/MCA. Thrombolysis in Brain Ischemia scale, with (grade ≥1) compared to without flow (grade 0), showed a sensitivity of 17.1%, specificity of 86.9%, positive PV of 62%, and negative PV of 46% for identifying LVO.
CONCLUSIONS: TCD is a valuable modality for evaluating arterial circulation in acute ischemic stroke patients, demonstrating significant potential as a screening tool for intravenous/intra-arterial lysis protocols.
摘要：
目的：经颅多普勒（TCD）可识别动脉闭塞的急性中风患者，其中治疗可能无法有效打开阻塞的血管。这项研究旨在研究多中心前瞻性研究（CLOTBUST-PRO）中TCD血流发现的临床效用和预后价值。
方法：在静脉溶栓前接受了紧急TCD评估的计算机断层扫描血管造影（CTA）颅内闭塞患者纳入分析。使用平均流速（MFV）比率评估TCD结果，比较两侧大脑中动脉（MCA）深度的倒数比（受影响的MCA与对侧MCAMFV[aMCA/cMCAMFV比]）。
结果：共有222例CTA颅内闭塞患者纳入研究（平均年龄：64±14岁，62%的男性）。88例患者有M1型MCA闭塞；基线平均美国国立卫生研究院卒中量表（NIHSS）评分为16分，24小时平均NIHSS评分为10分。aMCA/cMCAMFV比值<.6的灵敏度为99%，特异性为16%，阳性预测值(PV)为60%，阴性PV为94%，用于识别大血管闭塞（LVO），包括M1MCA，颈内动脉末端,或串联ICA/MCA。脑缺血溶栓量表,有流量(等级≥1)与无流量(等级0)相比，灵敏度为17.1%，特异性为86.9%，正PV为62%，和46％的负PV用于识别LVO。
结论：TCD是评估急性缺血性卒中患者动脉循环的一种有价值的方法，证明了作为静脉/动脉内溶解方案的筛选工具的巨大潜力。
方法：在静脉溶栓前接受了紧急TCD评估的计算机断层扫描血管造影（CTA）颅内闭塞患者纳入分析。使用平均流速（MFV）比率评估TCD结果，比较两侧大脑中动脉（MCA）深度的倒数比（受影响的MCA与对侧MCAMFV[aMCA/cMCAMFV比]）。
结果：共有222例CTA颅内闭塞患者纳入研究（平均年龄：64±14岁，62%的男性）。88例患者有M1型MCA闭塞；基线平均美国国立卫生研究院卒中量表（NIHSS）评分为16分，24小时平均NIHSS评分为10分。aMCA/cMCAMFV比值<.6的灵敏度为99%，特异性为16%，阳性预测值(PV)为60%，阴性PV为94%，用于识别大血管闭塞（LVO），包括M1MCA，颈内动脉末端,或串联ICA/MCA。脑缺血溶栓量表,有流量(等级≥1)与无流量(等级0)相比，灵敏度为17.1%，特异性为86.9%，正PV为62%，和46％的负PV用于识别LVO。
结论：TCD是评估急性缺血性卒中患者动脉循环的一种有价值的方法，证明了作为静脉/动脉内溶解方案的筛选工具的巨大潜力。
