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To better characterize (1) the success of endovascular recanalization and (2) the functional outcomes observed following thrombectomy for acute large vessel occlusion (LVO), Dr. Baracchini and colleagues prospectively followed 185 patients with acute anterior circulation LVO using serial transcranial color-coded ultrasonography postoperatively. All patients were treated within 6 hours of the time they were last known well, had moderate-to-severe deficits (NIHSS >6), and had favorable baseline CT findings (ASPECTS 6–10). After excluding patients who died within 1 week of treatment (8%), the investigators found that successful recanalization (TICI 2b or 3) was associated with a higher probability of normal peak systolic velocities on transcranial ultrasound than partial recanalization (TICI 2a), 96% vs 32%. However, early normalization of the blood flow velocity—irrespective of post-thrombectomy recanalization success—was strongly linked to better long-term outcomes using the modified Rankin Scale. Among those with normal blood flow velocities by 48 hours, 66% of patients with TICI 2b/3 recanalization and 57% of patients with TICI 2a recanalization achieved functional independence by 90 days. Higher velocities also correlated with an increased risk of intracranial hemorrhage, as suggested in previous literature. In response, Drs. Gattringer et al. found the elevated post-thrombectomy peak systolic velocity of the previously occluded artery alarming (279 cm/s in patients with TICI 2b/3). They also commented that other serologic and neuroimaging biomarkers of hyperperfusion injury might prove useful for prognostication after thrombectomy. Dr. Baracchini and colleagues recognize that their observed peak systolic velocities exceed what had been previously published, but they acknowledge that previous studies documented velocities 72 hours after thrombectomy as opposed to immediately following the procedure, as in this investigation.
To better characterize (1) the success of endovascular recanalization and (2) the functional outcomes observed following thrombectomy for acute large vessel occlusion (LVO), Dr. Baracchini and colleagues prospectively followed 185 patients with acute anterior circulation LVO using serial transcranial color-coded ultrasonography postoperatively. All patients were treated within 6 hours of the time they were last known well, had moderate-to-severe deficits (NIHSS >6), and had favorable baseline CT findings (ASPECTS 6–10). After excluding patients who died within 1 week of treatment (8%), the investigators found that successful recanalization (TICI 2b or 3) was associated with a higher probability of normal peak systolic velocities on transcranial ultrasound than partial recanalization (TICI 2a), 96% vs 32%. However, early normalization of the blood flow velocity—irrespective of post-thrombectomy recanalization success—was strongly linked to better long-term outcomes using the modified Rankin Scale. Among those with normal blood flow velocities by 48 hours, 66% of patients with TICI 2b/3 recanalization and 57% of patients with TICI 2a recanalization achieved functional independence by 90 days. Higher velocities also correlated with an increased risk of intracranial hemorrhage, as suggested in previous literature. In response, Drs. Gattringer et al. found the elevated post-thrombectomy peak systolic velocity of the previously occluded artery alarming (279 cm/s in patients with TICI 2b/3). They also commented that other serologic and neuroimaging biomarkers of hyperperfusion injury might prove useful for prognostication after thrombectomy. Dr. Baracchini and colleagues recognize that their observed peak systolic velocities exceed what had been previously published, but they acknowledge that previous studies documented velocities 72 hours after thrombectomy as opposed to immediately following the procedure, as in this investigation.
Footnotes
Author disclosures are available upon request (journal{at}neurology.org).
- Received March 9, 2020.
- Accepted in final form March 6, 2020.
- © 2020 American Academy of Neurology
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