Rapid Evaluation of Large Vessel Occlusion for Mechanical Thrombectomy Using Carotid Duplex Ultrasound

• Published in: Internal Medicine Vol. 62; no. 5; pp. 703 - 710
• Main Authors: Itabashi, Ryo, Shigehatake, Yuya, Saito, Takuya, Endo, Kaoru, Fukuma, Kazuki, Kobayashi, Yuya, Kawabata, Yuichi, Yazawa, Yukako, Matsumoto, Yasushi, Inoue, Manabu, Koga, Masatoshi
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Society of Internal Medicine 01-03-2023; Japan Science and Technology Agency
• Subjects: Angiography; Carotid artery; carotid duplex ultrasound; Cerebral blood flow; Humans; Internal medicine; Ischemia; large vessel occlusion; Magnetic Resonance Angiography; mechanical thrombectomy; Original; Prospective Studies; Stroke; Thrombectomy; Ultrasonic imaging; Ultrasonography, Carotid Arteries; Ultrasound; United States; Veins & arteries; United States; mechanical thrombectomy; stroke; large vessel occlusion; carotid duplex ultrasound
• ISSN: 0918-2918; 1349-7235
• DOI: 10.2169/internalmedicine.0029-22

Objectives This study clarified the usefulness of carotid duplex ultrasound (CDU) in evaluating large vessel occlusion (LVO) in patients with acute stroke planned to be treated with mechanical thrombectomy (MT). Methods This study was single-center, prospective, observational trial. If the ratio of end-diastolic velocity in the common carotid arteries was ≥1.4, or diastolic flow in the affected internal carotid artery (ICA) was absent on CDU, patients were immediately transferred to the angio-suite without additional cerebrovascular imaging. Clinical parameters, including time metrics and outcomes, were evaluated in participants. Patients We enrolled stroke patients with a National Institutes of Health Stroke Scale score ≥6 and Alberta Stroke Program Early CT score ≥6 in whom MT could be initiated within 6 hours of the stroke onset. Results Among 140 patients screened during the study period, 48 were ultimately enrolled. Twenty-seven patients were diagnosed with LVO by CDU alone. CDU offered 83% sensitivity and 82% specificity for identifying the occlusion of the ICA or M1 segment of the middle cerebral artery. Among the 29 total patients treated with MT, 20 (67%) showed a modified Rankin Scale score ≤2 at 90 days. The door-to-puncture time was significantly shorter in patients evaluated by CDU alone (34 minutes) than in those evaluated by magnetic resonance angiography after CDU (47.5 minutes, p<0.001). Conclusion CDU might reduce the time metrics for early initiation of MT with good sensitivity and specificity in identifying LVO.