AUTHOR=Jumah Ammar , Batista Savio , Yelam Theja , Anderson Aaron , Sigman Erika , Dolia Jaydevsinh N. , Grossberg Jonathan A , Pabaney Aqueel , Martins Pedro , Nogueira Raul G , Haussen Diogo C. 

TITLE=No impact of intravenous thrombolysis on post thrombectomy transcranial Doppler pulsatility index

JOURNAL=Frontiers in Neurology

VOLUME=Volume 16 - 2025

YEAR=2025

URL=https://www.frontiersin.org/journals/neurology/articles/10.3389/fneur.2025.1681572

DOI=10.3389/fneur.2025.1681572

ISSN=1664-2295

ABSTRACT=BackgroundWhile transcranial Doppler (TCD) studies are beneficial in evaluating macrovascular recanalization post mechanical thrombectomy (MT), they may have a role in estimating microvascular reperfusion. We aim to (1) evaluate if TCD-derived pulsatility index (PI) ratio is different in large vessel occlusion stroke (LVOS) patients that received intravenous thrombolysis (IVT), indicating potential beneficial impact on microvascular reperfusion, and (2) assess whether TCD metrics correlate with clinical and safety outcomes.MethodsThis is a retrospective analysis of consecutive patients treated with MT for middle cerebral artery (MCA) M1 or intracranial internal carotid artery terminus (ICA) LVOS from January 2018 to June 2024. Patients with Expanded Thrombolysis in Cerebral Infarction (eTICI) grade 2c-3 reperfusion and high-quality TCD studies within 24 h of their procedure were included. Ipsilateral and contralateral mean flow velocity and PI were collected for the MCA and anterior cerebral artery (ACA). The primary outcome was the comparison of MCA PI ratios between IVT and non-IVT arms. Secondary outcome was the association between TCD-derived metrics and parenchymal hemorrhages (PH) or modified Rankin Scale at 90-days.ResultsOf 1,962 patients, only 234 met the inclusion criteria. The median age was 65 (IQR 56–76) years, 45% were females, and 75.6% had MCA-M1 occlusions. Median ASPECTS was 8 (7–9), NIHSS 18 (13–22) and IVT was administered in 66 (28.2%) patients. Of all patients, 20 (8.5%) developed PH, 89 (50.3%) were independent, and 37 (20.9%) were dead by day 90. Adjusted analyses revealed no significant difference in MCA PI ratios between IVT and non-IVT groups (0.96 vs. 1.01, p = 0.36), and no significant associations between TCD metrics and PH or mRS at 90-days.ConclusionIn this retrospective study of LVOS with excellent reperfusion, no differences were found in PI ratio between IVT and non-IVT groups, and no associations between TCD parameters and PH or mRS at 90-days.