The value of flow velocity alterations measured by carotid Doppler in the diagnosis of acute anterior ischemic stroke

Abstract Background Acute ischemic stroke is a leading cause of mortality and long‐term disability. Conventional imaging methods like CT and MRI, while essential, are limited by cost, accessibility, and the need for patient transport. Carotid Doppler ultrasonography is a non‐invasive, low‐cost tool that can be performed bedside, yet its utility in detecting hemodynamic changes in acute ischemic stroke—particularly in the absence of structural stenosis—requires further evaluation. Methods This prospective case‐control study included 64 acute anterior ischemic stroke (AAIS) patients and 64 healthy controls. Using bedside carotid Doppler ultrasound, bilateral measurements of velocity time integral (VTI), peak systolic velocity (PSV), and arterial diameter were obtained. VTI and PSV indices were calculated as the percentage difference between right and left sides. Diagnostic accuracy was assessed through receiver operating characteristic (ROC) analysis and logistic regression. Results The AAIS group showed significantly higher VTI and PSV indices compared to controls ( p < 0.001). ROC analysis demonstrated good diagnostic performance (area under curve: 0.789 for VTI and 0.865 for PSV). At optimal cut‐off values (VTI > 5.1%; PSV > 6.35%), sensitivity and specificity exceeded 73% for both. Logistic regression identified both indices as independent predictors of AAIS (OR: 6.948 for VTI, OR: 13.461 for PSV), and the combined model explained 53.7% of stroke likelihood (Nagelkerke R 2 = 0.537). Conclusion VTI and PSV indices measured by carotid Doppler ultrasound are effective, noninvasive diagnostic tools for AAIS. Their bedside applicability makes them especially valuable in emergency settings where rapid decision‐making is crucial.