ORIGINAL RESEARCH article
Front. Neurol.
Sec. Endovascular and Interventional Neurology
No Impact of Intravenous Thrombolysis on Post Thrombectomy Transcranial Doppler Pulsatility Index
Provisionally accepted
Ammar Jumah
Sávio Batista
Theja YelamAaron AndersonErika Sigman
Jaydevsinh Dolia
Jonathan GrossbergAqueel Pabaney
Pedro Nascimento MartinsRaul G Nogueira
Diogo C Haussen*- Emory University, Atlanta, United States
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ABSTRACT Background: While 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. Methods: This is a retrospective analysis of consecutive patients treated with mechanical thrombectomy (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 hours 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. Results: Of 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 patients. Of all patients, 8.5% developed PH, 50.2% were independent, and 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. Conclusion: In 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.
Keywords: Acute ischemic stroke, transcranial Doppler, No-reflow, Pulsatility index, cerebral autoregulation
Received: 07 Aug 2025; Accepted: 07 Nov 2025.
Copyright: © 2025 Jumah, Batista, Yelam, Anderson, Sigman, Dolia, Grossberg, Pabaney, Nascimento Martins, Nogueira and Haussen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Diogo C Haussen, diogo.haussen@emory.edu
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