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Original research
Increased middle cerebral artery mean blood flow velocity index after stroke thrombectomy indicates increased risk for intracranial hemorrhage
  1. Markus Kneihsl1,
  2. Kurt Niederkorn1,
  3. Hannes Deutschmann2,
  4. Christian Enzinger1,2,
  5. Birgit Poltrum1,
  6. Renate Fischer1,
  7. Daniela Thaler1,
  8. Christina Hermetter1,
  9. Gerit Wünsch3,
  10. Franz Fazekas1,
  11. Thomas Gattringer1
  1. 1 Department of Neurology, Medical University of Graz, Graz, Austria
  2. 2 Division of Neuroradiology, Vascular and Interventional Radiology, Department of Radiology, Medical University of Graz, Graz, Austria
  3. 3 Institute of Medical Informatics, Statistics and Documentation, Medical University of Graz, Graz, Austria
  1. Correspondence to Dr Thomas Gattringer, Department of Neurology, Medical University of Graz, Graz 8036, Austria; thomas.gattringer{at}


Background and purpose Cerebral hyperperfusion has been related to the risk of intracranial hemorrhage (ICH) in stroke patients after vessel recanalization therapy. We hypothesized that after successful mechanical thrombectomy for acute anterior circulation stroke, hemodynamics detectable by transcranial Duplex (TCD) sonography would vary, and that increased blood flow velocities would be associated with ICH.

Methods We retrospectively identified all ischemic stroke patients with successful endovascular recanalization for anterior circulation vessel occlusion (Thrombolysis in Cerebral Infarction 2b–3) between 2010 and 2017. We reviewed their postinterventional TCD examinations for mean blood flow (MBF) velocities of the recanalized and contralateral middle cerebral artery (MCA) and searched for an association with postinterventional ICH and clinical outcome.

Results 123 stroke patients (mean age 63±14 years, 40% women) with successful anterior circulation thrombectomy were analyzed. Of those, 18 patients had postinterventional ICH. ICH patients had an increased MCA MBF velocity index (=MBF velocity of the recanalized divided by the contralateral MCA) compared with non-ICH patients (1.32±0.39 vs 1.02±0.32, P<0.001). In multivariate analysis, a higher MCA MBF velocity index was associated with postinterventional ICH and poor 90 day outcome.

Conclusions A high MCA MBF velocity index on TCD after successful recanalization therapy for anterior circulation stroke indicates a risk for postinterventional ICH and worse prognosis.

  • stroke
  • thrombectomy
  • ultrasound
  • blood flow
  • hemorrhage

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  • Contributors TG and FF conceived the study and designed the research question. BP, RF, DT, CH, GW, and MK acquired the data. MK analyzed the data, which was discussed with TG, FF, KN, CE, and HD. MK, TG, and FF wrote the first draft of the manuscript and KN, CE, HD, BP, RF, CH, and DT commented on the final version. All authors had full access to all of the data (including statistical reports and tables) in the study and take responsibility for the integrity of the data and accuracy of the data analysis. All authors have read and approved the final manuscript and agreed to be accountable for all aspects of the work.

  • Competing interests None declared.

  • Ethics approval The study was approved by the ethics committee of the Medical University of Graz.

  • Provenance and peer review Not commissioned; externally peer reviewed.