Association of the Transcranial Doppler Pulsatility Index, Central Pulse Pressure, and Pulse Wave Velocity with White Matter Hyperintensities in Patients with Acute Ischemic Stroke

This retrospective single-center study examined whether the transcranial Doppler pulsatility index (PI), central pulse pressure (cPP), and pulse wave velocity (PWV) were associated with the white matter hyperintensity (WMH) severity in acute ischemic stroke.Three hundred and twenty-four patients who underwent brain magnetic resonance imaging, transcranial Doppler ultrasonography, and arterial stiffness assessment were analyzed.The WMH severity was graded using the Fazekas scale.The associations between the hemodynamic markers and Fazekas grade were evaluated using the Spearman correlation, trend analysis, and ordinal logistic regression adjusted for age, sex, hypertension, diabetes mellitus, hyperlipidemia, smoking, atrial fibrillation, and previous stroke.Univariate analyses revealed PI, PWV, and cPP to be significantly associated with a higher Fazekas grade.In stepwise ordinal logistic models, the model including PI and PWV showed the best balance between fit and complexity.In the final model, the PI (odds ratio [OR], 1.155 per 0.1 increase; 95% confidence interval [CI], 1.048~1.272;P=0.004) and PWV (OR, 1.312 per 1 m/s increase; 95% CI, 1.166~1.475;P<0.001) remained independently associated with a higher Fazekas grade.cPP did not add explanatory value after PI and PWV were included.Thus, intracranial pulsatility and systemic arterial stiffness may provide complementary information for assessing WMH severity.