Same lesion, different outcomes: hemodynamic correlates of ischemic stroke in unilateral high-grade internal carotid artery stenosis or occlusion - a retrospective transcranial Doppler study.

Background: High-grade stenosis or occlusion of the internal carotid artery (ICA) is a leading cause of ischemic stroke (IS). However, patients with severe ICA lesions often experience varying outcomes. This study investigated the relationship between cerebral hemodynamics, as detected by transcranial Doppler ultrasound (TCD), and the occurrence of IS in patients with high-grade stenosis or occlusion of unilateral ICA. Methods: A total of 272 patients diagnosed with high-grade stenosis or occlusion of unilateral ICA were retrospectively enrolled in the study. The baseline data, laboratory examination results, TCD, duplex scan examination of neck vessels and imaging information were collected. The correlation between TCD hemodynamic parameters and IS was assessed by dividing the included patients into a stroke group and a non-stroke group according to the presence or absence of an IS at this admission. Binary logistic regression and trend tests were used to analyze the data. Results: Hemodynamic parameters measured by TCD, including ipsilateral middle cerebral artery (MCA) flow velocity, P2 segment of the posterior cerebral artery (PCA-P2) flow velocity, and reversal of ophthalmic artery flow (ROAF), were identified as factors associated with IS. In particular, lower MCA flow velocity and higher PCA-P2 flow velocity were associated with the presence of IS. Conclusion: In patients with high-grade stenosis or occlusion of unilateral ICA, hemodynamics measured by TCD is associated with the presence of IS. However, prospective studies are warranted before these TCD parameters can be applied to guide the timing of intervention for ICA lesions.