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Observational Study
. 2025 Jun;32(6):e70224.
doi: 10.1111/ene.70224.

Prognostic Value of Cerebral Hemodynamics Assessment on 24-h Transcranial Color-Coded Doppler Following a Successful Thrombectomy

Sabrina Rossi  1   2 , Matteo Paolucci  3 , Giorgia Arnone  3 , Guido Bigliardi  4 , Marco Longoni  5 , Giuseppe Pulito  6 , Cristiano Azzini  2   7 , Lorenzo Coppo  8 , Monia Russo  9 , Georgios Tsivgoulis  10 , Odysseus Kargiotis  11 , Vincenzo Inchingolo  12 , Vittoria Maria Sarra  13 , Daniela Monaco  14 , Ludovica Migliaccio  3 , Riccardo Ricceri  4 , Michele Romoli  5 , Donatella Mastria  6 , Maura Pugliatti  1   2 , Mauro Gentile  3 , Andrea Zini  3 , Giovanni Malferrari  3 ; HYs Study Group
Collaborators, Affiliations
Observational Study

Prognostic Value of Cerebral Hemodynamics Assessment on 24-h Transcranial Color-Coded Doppler Following a Successful Thrombectomy

Sabrina Rossi et al. Eur J Neurol. 2025 Jun.

Abstract

Background and aims: This study evaluates the distribution and prognostic role of transcranial color-coded Doppler (TCCD) spectral patterns following a successful endovascular thrombectomy (EVT).

Methods: This multicenter prospective study included patients with internal carotid or middle cerebral artery (MCA) occlusion treated in the early time window (< 6 h) with a successful EVT (mTICI ≥ 2b), without symptomatic hemorrhagic transformation within 24 h. TCCDs were performed 24-48 h and 7 days from EVT. TCCD flow was graded by Consensus on Grading Intracranial Flow Obstruction (COGIF) score (1: no flow; 2-3: low flow; 4a: normal; 4b: residual stenosis; 4c: hyperperfusion). MCA flow velocities were compared between sides and time points. Outcomes were clinical improvement (decrease of 8 points/30% on day 7 NIHSS vs. baseline) and three-month mRS.

Results: 188 ischemic stroke patients were included (48% female, median age 77). The median NIHSS was 16 at admission and 3 at day 7. Day 1 TCCD showed slightly higher velocities in the treated MCA compared to the contralateral MCA, without significant differences between day 1 and day 7. Despite mTICI ≥ 2b, 13/187 (7%) patients showed a partial recanalization or residual stenosis at 24 h. Clinical improvement was lacking in 27 patients (14.4%). COGIF scores 3 and 4b at day 1 were significantly associated with lack of improvement at day 7 (aOR 0.03, 95% CI 0.01-0.16, p < 0.001) and worse mRS score at 3 months (mRS ordinal shift analysis, aOR 7.78, 95% CI 2.16-28.54, p = 0.002).

Conclusions: Day 1 post-EVT TCCD COGIF score, but no flow velocities alone, are associated with clinical outcomes.

Keywords: COGIF; cerebral blood flow; hyperperfusion; mechanical thrombectomy; no‐reflow.

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Conflict of interest statement

The authors declare no conflicts of interest.

Figures

FIGURE 1
FIGURE 1
Patient flow diagram.
FIGURE 2
FIGURE 2
TCCD velocities at T0 (24–48 h) and T1 (7 days), proximally (left) and distally (right) in treated and contralateral (healthy) middle cerebral artery.
FIGURE 3
FIGURE 3
(a) Sankey diagram of recanalization status: At 24 h, three patients were COGIF 3 despite being TICI 3, and 10 patients were COGIF 4b; (b) stacked bar percent of TCCD T0—COGIF by Clinical Improvement at day 7: NIHSS decrease of 8 points/30% was more frequent in COGIF 4a and 4c; (c) Ordinal shift analysis of 3‐month mRS: COGIF 3‐4b yields a significantly poorer functional outcome.
See this image and copyright information in PMC

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