What question did this study set out to answer?

This research aims to determine whether transcranial Doppler metrics can predict tissue injury severity observed on dual-energy CT following endovascular therapy.

February 2, 2026

Abstract DP345: Transcranial Doppler Pulsatility Index Predicts Worsening Reperfusion Injury on Dual-Energy CT After EVT

Key Points

This research aims to determine whether transcranial Doppler metrics can predict tissue injury severity observed on dual-energy CT following endovascular therapy.
Conducted a single-center retrospective analysis of patients with MCA or intracranial ICA occlusion
Analyzed early TCD and DECT outcomes post-successful EVT
Compared clinical, procedural, and TCD characteristics among different DECT outcome grades
Employed ordinal logistic regression to assess associations of TCD predictors with DECT outcomes
Among 88 patients, DECT grades included 38% no staining, 41% contrast staining, and 22% hemorrhage
Ipsilateral pulsatility index significantly increased with worsening DECT grades, indicating higher injury severity
Longer last-known-well-to-arrival times were linked to higher DECT grades
Discharge modified Rankin Scale scores worsened as DECT grades increased
Ipsilateral pulsatility index independently predicted higher DECT grades in adjusted models

Abstract

Background: Dual-energy CT (DECT) is used to differentiate contrast staining (blood-brain-barrier disruption) versus hemorrhage, which represent a spectrum of reperfusion injury after endovascular therapy (EVT). Transcranial Doppler (TCD) hemodynamic measures have been associated with long-term outcomes post-EVT. We tested whether key TCD metrics predict tissue injury severity on DECT after EVT. Methods: Single-center retrospective analysis of a prospective registry of patients with MCA or intracranial ICA occlusion who underwent early TCD and DECT after successful EVT (eTICI ≥2b50) from 8/2023-3/2025. Key DECT outcomes: no staining (NS=1), contrast staining (CS=2), or hemorrhage (HT=3). Key TCD predictors: mean flow velocity (MFV), peak systolic velocity (PSV), end-diastolic velocity (EDV), and pulsatility index (PI). Clinical, procedural and TCD characteristics were compared amongst DECT groups 1-3. Ordinal logistic regression measured association of TCD predictors and DECT outcome grades 1-3. Covariates included: baseline NIHSS, last-known-well-to-arrival (LKWA), ASPECTS, MCA-M1 occlusion, angiographic collaterals (good/moderate vs poor) and eTICI grade. Results: Of 88 patients, DECT grades were: NS 33 (38%), CS 36 (41%), HT 19 (22%). Ipsilateral PI (iPI) increased across grades NS 0.97 (0.84-1.19), CS 1.19 (0.94-1.39), HT 1.16 (1.06-1.31); p=0.026, while ipsilateral MFV/PSV/EDV did not differ (all p≥0.2). Longer LKWA tracked with higher grade 3.7 h (2.1-8.9), 6.9 h (3.3-14.2), 12.1 h (5.2-19.3); p=0.006. DBP and MAP varied by grade DBP: 68.8, 63.3, 66.0; p=0.021; MAP: 89.5, 84.3, 89.0; p=0.036. Discharge mRS worsened with grade 4 (2-4), 4 (3-4), 4 (4-5); p=0.019. MCA-M1 occlusion was more frequent in NS than CS/HT 84.9% vs 55.6%/57.9%; p=0.022. Good collaterals were less common in CS/HT vs NS 13.9%/21.1% vs 39.4%; p=0.046. Adjusted models: iPI independently predicted higher DECT grade (aOR 6.13, 95% CI 1.39-27.05; p=0.017) and LKWA per hour remained significant (aOR 1.04, 1.01-1.08; p=0.011); ASPECTS showed a protective trend (aOR 0.84, 0.67-1.05; p=0.12). Conclusions: Post-EVT iPI, but not velocity indices (ipsilateral MFV/PSV/EDV), predict reperfusion injury grade on DECT. This supports the notion that increased microvascular resistance rather than focal hyperemia may serve as a biomarker to ischemic reperfusion injury. These findings may help individualize blood pressure management after EVT and need to be tested in future studies.

Abstract DP345: Transcranial Doppler Pulsatility Index Predicts Worsening Reperfusion Injury on Dual-Energy CT After EVT

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