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(Stroke. 2000;31:2942.)
© 2000 American Heart Association, Inc.

Original Contributions

The Quest for Early Predictors of Stroke Evolution

Can TCD Be a Guiding Light?

Claudio Baracchini, MD; Renzo Manara, MD; Mario Ermani, MD Giorgio Meneghetti, MD

From the Department of Neurological Sciences, University of Padua (Italy).

Correspondence to G. Meneghetti, Department of Neurological Sciences, University of Padua, via Giustiniani 5, 35128 Padua, Italy. E-mail segneuro{at}ux1.unipd.it

Background and Purpose—The present study aimed at evaluating the prognostic value of transcranial Doppler ultrasonography (TCD) in the acute phase of ischemic stroke, when major therapeutic decisions must be made.

Methods—Seventy-three patients with a first-ever ischemic hemispheric stroke underwent neurological assessment according to the Unified Neurological Stroke Scale, clinical subgrouping according to the criteria of Bamford, CT scan, cervical duplex sonography, and TCD, all within 12 hours from stroke onset. TCD was repeated on days 2 and 7. Patients were followed for 90 days, during which we calculated the fatality rate and then assessed clinical outcome.

Results—Emergency TCD revealed middle cerebral artery (MCA) no-flow in 24 cases and MCA asymmetry in 30 subjects. Serial TCD showed early (<24 hours) MCA recanalization in 6 patients. After 90 days, no patient with MCA occlusion at admission was autonomous, while 17 of 19 patients (89.5%) with a normal baseline TCD were independent. The fatality rate at 3 months was 21% but was 46% in patients with MCA occlusion and 61% in patients without signs of early MCA recanalization. Total anterior circulation infarct and abnormal TCD were significantly correlated (P<0.001) with higher mortality rate and worse outcome (Barthel Index score 60), whereas early CT ischemic signs and severe carotid disease were not. Furthermore, TCD identified within the total anterior circulation infarct subgroup 2 prognostic clusters according to MCA patency at admission (P<0.001). Logistic regression selected normal baseline TCD as an independent predictor of good long-term outcome and MCA no-flow as an independent predictor of disability or death.

Conclusions—TCD findings play an important role in the early prognosis of anterior circulation stroke, providing possible guidance for therapeutic interventions.

Key Words: cerebral ischemia • stroke outcome • ultrasonography, Doppler, transcranial

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