Transcranial Doppler After Endovascular Treatment to Evaluate Collateral Status and Outcomes in Patients With Large‐Vessel Occlusion
Bibliographic record
Abstract
Background: Recent advances in endovascular therapy (EVT) have led to significant improvements in functional outcomes of patients with stroke. However, early neurological deterioration after EVT has remained a concerning issue. This cohort study was designed to assess the feasibility of early transcranial Doppler (TCD) after EVT and to identify associations between TCD findings and early neurological deterioration. Methods: Between October 16, 2020, and March 28, 2021, we recruited 20 patients with acute ischemic stroke with large-vessel occlusion who underwent EVT. Five patients were excluded because of a poor temporal window; 2 had an unsuccessful intervention. Using TCD, we measured peak systolic velocity, end-diastolic velocity, mean flow velocity, and pulsatility index for all selected arteries before and within 60 minutes after EVT. We also examined the association between active leptomeningeal collateral flow after EVT and early neurological deterioration. Patients were followed for 3 months, and disability was measured using the modified Rankin scale. Results: Two patients had early neurological deterioration with elevated blood pressure and active leptomeningeal flow despite successful EVT. Most patients with poststroke disability (modified Rankin scale>2) had either flow diversion or active leptomeningeal collateral flow in the presence of elevated blood pressure (≥170/93 mm Hg). In cases without early neurological deterioration and in those with a modified Rankin scale<2, we did not observe any flow diversion or active leptomeningeal collateral. They also had a blood pressure of ≤155/85 mm Hg after EVT. All patients with hemorrhagic transformation had evidence of hyperemia on TCD. Conclusions: Early TCD is a feasible and safe approach to evaluate cerebral blood flow before and after EVT and identify those at risk of early neurological deterioration. For the next phase of this study, we plan to manage blood pressures based on individualized cerebral flow and the presence of active collateral arteries after EVT.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.002 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.000 |
| Bibliometrics | 0.001 | 0.000 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".