Early cerebral hemodynamic patterns after endovascular thrombectomy: a prospective TCCD analysis of aspiration and combined techniques

BACKGROUND: Early cerebral hemodynamic changes after successful endovascular thrombectomy (EVT) may provide additional information regarding postprocedural cerebral circulation, but their relationship to thrombectomy technique and subsequent hemodynamic patterns remains incompletely understood. METHODS: In this prospective single-center cohort study, adults with acute anterior-circulation large-vessel occlusion who achieved successful reperfusion after thrombectomy underwent transcranial color-coded Doppler (TCCD) examinations at 1 hour and 24 hours. Symptomatic-side middle cerebral artery mean flow velocity (MFV), pulsatility index (PI), and Lindegaard ratio (LR) were recorded. Patients were classified at 24 hours as having normal flow, hyperemia, or vasospasm. Early hemodynamic findings were compared between aspiration and combined thrombectomy techniques, and receiver operating characteristic and multivariable logistic regression analyses were used to identify predictors of abnormal 24-hour hemodynamic patterns. RESULTS: A total of 116 patients were analyzed. Compared with aspiration thrombectomy, the combined-technique group had higher symptomatic-side MCA MFV and LR at both 1 hour and 24 hours. At 1 hour, MCA MFV and LR predicted abnormal 24-hour hemodynamic patterns with area under the curve (AUC) values of 0.805 and 0.791, respectively. In multivariable models, higher ASPECTS (Alberta Stroke Program Early CT Score) was independently protective, whereas higher 1-hour MCA MFV and higher 1-hour MCA MFV and higher 1-hour LR were independently associated with abnormal 24-hour hemodynamic patterns. Patients with abnormal 24-hour patterns appeared to have lower rates of favorable 90-day functional outcome. CONCLUSIONS: Early Doppler assessment after successful thrombectomy may provide additional information regarding postprocedural cerebral hemodynamic responses. Elevated early MCA MFV and LR values were associated with Doppler-defined abnormal hemodynamic patterns and may warrant further investigation in larger studies.