Virginia Commonwealth University
Endovascular thrombectomy (EVT) improves outcomes in acute ischemic stroke caused by large vessel occlusion. Despite successful recanalization, early neurological deterioration (END) remains frequent and is associated with poor outcomes. Transcranial Doppler (TCD) provides noninvasive, real-time assessment of cerebral blood flow velocities and may identify hemodynamic patterns associated with deterioration after EVT. PRECISE-TCD is a prospective, single-center observational study enrolling 180-300 patients undergoing EVT for anterior circulation large vessel occlusion at a tertiary academic medical center. Serial TCD examinations are performed immediately after EVT, daily for 72 hours, and as close as possible to early neurological deterioration events or clinically indicated head CT within 72 hours. The primary outcome is the association between TCD-derived hemodynamic parameters and END within 72 hours. Secondary outcomes include NIHSS at 24 hours and discharge, discharge disposition, and modified Rankin Scale at 90 days.
PRECISE-TCD is a single-center, prospective, observational study designed to evaluate the association between transcranial Doppler (TCD)-derived cerebral hemodynamic parameters and neurological outcomes in patients with acute ischemic stroke (AIS) after endovascular thrombectomy (EVT). The study will be conducted at Virginia Commonwealth University (VCU) Medical Center in Richmond, Virginia. The study has received IRB approval at VCU under protocol HM20032561 and will be conducted in accordance with the Declaration of Helsinki and institutional regulatory requirements. Eligible participants a…
Inclusion Criteria: * Anterior circulation large vessel occlusion, including ACA, MCA, or ICA stroke, treated with endovascular thrombectomy, including tandem occlusions * Age ≥ 18 years * Ability to detect an adequate acoustic window via TCD. Exclusion Criteria: * Inadequate acoustic windows defined as lack of bilateral MCA signal at standard depths. * Pregnancy * Incarceration
Serial non-invasive TCD monitoring will be performed as soon as possible after EVT, daily for 72 hours, and when possible, close to any neurological deterioration or head CT obtained within 72 hours after EVT. TCD parameters include PSV, EDV, MFV, and PI measured in bilateral MCA, ACA, PCA, carotid siphon, vertebrobasilar arteries, and ophthalmic artery territories. Collateralization patterns, including ACA flow reversal, ophthalmic artery flow reversal, and high-flow ACA or PCA patterns relative to MCA flow, will also be assessed.
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