Implicaciones diagnósticas, pronósticas y terapéuticas del dúplex color transcraneal en el ictus isquémico agudo: validación de los grados TIBI y COGIF / Diagnostic, prognostic and therapeutic implications of transcranial color-coded duplex sonography in acute ischemic stroke: TIBI and COGIF scores validation

Objetivo. Describir la información aportada por el dúplex color transcraneal (DCTC) en pacientes con ictus isquémico agudo, analizando la relación entre los hallazgos del DCTC, la gravedad y el pronóstico, así como su utilidad en la toma de decisiones terapéuticas. Pacientes y métodos. Analizamos los DCTC realizados a pacientes con ictus agudo de menos de seis horas de evolución. Recogimos la existencia de oclusión arterial empleando las clasificaciones TIBI (Thrombolysis in Brain Ischemia) y COGIF (Consensus on Grading Intracranial Flow Obstruction). Determinamos la recanalización arterial a las 24 horas del ictus empleando criterios TIBI y COGIF. Consideramos buena evolución funcional puntuaciones en la escala de Rankin de 0 a 2 a los tres meses. Resultados. Realizamos DCTC en 104 pacientes, 85 tratados con trombólisis intravenosa. Objetivamos oclusión arterial en el 79,8%. La detección de una oclusión arterial mediante DCTC permitió indicar tratamiento endovascular en el 23,1% de los pacientes. La presencia de oclusión arterial se asoció a mayor gravedad del ictus. Detectamos recanalización arterial en el 44,1% según los criterios TIBI y en el 45,8% según los criterios COGIF. El 80,8% de los pacientes que recanalizaron y sólo el 39,5% de los que no recanalizaron obtuvieron una buena evolución funcional a los tres meses. La recanalización dependió de la localización de la oclusión arterial. Conclusiones. El DCTC es útil para detección y localización de oclusión arterial, aporta información pronóstica valiosa y permite seleccionar pacientes para el empleo de terapias endovasculares. La información aportada por las clasificaciones TIBI y COGIF es equiparable (AU)

Aim. To describe the information provided by transcranial color-coded duplex (TCCD) sonography for therapeutic decision making in patients with acute ischemic stroke and to analyze the relationship between TCCD findings and the severity and prognosis of stroke. Patients and methods. TCCD performed within the six first hours after an acute ischemic stroke were analyzed in our institution. The presence of an arterial occlusion and its location were collected using TIBI (Thrombolysis in Brain Ischemia) and COGIF (Consensus on Grading Intracranial Flow Obstruction) criteria. Arterial recanalization within 24 hours after stroke was determined using TIBI and COGIF criteria. Favorable functional outcome was defined as a modified Rankin scale from 0 to 2 at three months. Results. TCCD was performed in 104 patients, 85 were treated with intravenous thrombolysis. Arterial occlusion was detected in 79.8% of patients. The detection of arterial occlusion with TCCD allowed the selection for endovascular treatment in 23.1% of patients. Arterial occlusion was associated with a higher severity of stroke. Recanalization was detected in 44.1% using TIBI and 45.8% according to COGIF criteria. 80.8% of recanalized patients and only 39.5% of not recanalized had a favorable functional outcome at three months. Recanalization rate depended on the location of arterial occlusion. Conclusion. TCCD is a useful technique for the detection and location of arterial occlusion. It provides valuable prognostic information and allows selecting patients for endovascular recanalizing therapies. TIBI and COGIF scores provide a comparable information (AU)

Vascular imaging before intravenous thrombolysis: consequences of in-hospital delay in applying two diagnostic procedures.

BACKGROUND: Vascular imaging is increasingly used for diagnosis of arterial occlusions in acute ischemic stroke (AIS) patients. Our aim was to determine whether computed tomography angiography (CTA) and Doppler/duplex ultrasound (DUS) before intravenous thrombolysis (IVT) is associated with a delay in time-to-treatment. METHODS: Observational analysis of a prospective cohort of AIS patients treated with IVT from January 2009 to December 2012. Patients were classified into three groups: the noncontrast computed tomography (NCCT) group (patients studied only with NCCT before IVT), CTA group (patients who underwent CTA in addition to NCCT), and the DUS group (patients studied with NCCT+DUS). RESULTS: We treated 244 patients: 116 patients (47.5%) were studied with NCCT, 79 (32.4%) with CTA, and 49 (20.1%) with DUS. Door-to-needle time was significantly higher in the CTA group (median 60 [48-77] minutes) than in the NCCT group (51.5 [40-65]) and DUS group (48 [42-61]) (P = .008). No differences were observed for onset-to-door time and onset-to-needle time. In the multivariate linear regression analysis, onset-to-door time, prehospital stroke code activation, and performance of CTA influenced door-to-needle time. CONCLUSIONS: Performing CTA before IVT seems to increase door-to-needle time. Vascular imaging based on DUS should be considered only if this does not lead to in-hospital delay.