Combined ipsilateral peak systolic velocity and ASPECTS are associated with early neurological deterioration after endovascular thrombectomy: a prospective cohort study

This study aimed to assess whether a predictive model combining the Alberta Stroke Program Early CT Score (ASPECTS) and post-endovascular thrombectomy (EVT) transcranial Doppler (TCD) parameters could improve the prediction of early neurological deterioration (END) in patients with large artery occlusion (LAO) stroke after successful recanalization. In this prospective study, we enrolled 87 consecutive patients with anterior circulation LAO who achieved successful recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] grade ≥2b), underwent post-EVT TCD monitoring within 48 h, and had baseline ASPECTS assessment. Bilateral middle cerebral artery (MCA) flow velocities were measured, and key hemodynamic indices were subsequently calculated. The prespecified primary outcome was END within 72 h; secondary outcomes included functional status at 90 days. Among the 87 successfully recanalized patients, END occurred in 21.8% (n = 19) within 72 h after EVT. Compared with the non-END group, patients who developed END exhibited significantly higher ipsilateral MCA flow velocities, including peak systolic, end-diastolic, and mean flow velocities, as well as a significantly higher ipsilateral-to-contralateral mean flow velocity ratio. Multivariable analysis identified lower baseline ASPECTS (odds ratio [OR], 0.50, 95% confidence interval [CI], 0.31–0.80) and higher ipsilateral peak systolic velocity (iPSV) (OR, 2.15, 95% CI, 1.08–4.28) as independent predictors of END. Restricted cubic spline analysis suggested an approximately linear association between iPSV and END risk. A combined model incorporating iPSV and ASPECTS demonstrated superior discriminative performance in predicting END (area under the curve [AUC], 0.801; 95% CI, 0.700–0.902), outperforming either parameter alone. A model integrating post-EVT hemodynamic (iPSV) and baseline imaging (ASPECTS) data significantly improves the prediction of END after successful EVT. This multimodal approach, which showed superior discriminative ability (AUC = 0.801), may facilitate early risk stratification and support tailored clinical management. This prospective observational study was registered with the National Clinical Research Center of China on June 19, 2024 (Registration No. MR-36-24-042352). The study was registered during the enrollment period.