Predictive value of transcranial Doppler hemodynamic parameters for short-term prognosis in patients with anterior circulation small artery occlusion stroke

doi:10.3877/cma.j.issn.1672-6448.2026.03.008

Abstract

Abstract:

Objective

To investigate the relationship between acute-phase cerebral hemodynamic parameters measured by transcranial Doppler ultrasonography (TCD) and 3-month functional outcome in patients with anterior circulation small artery occlusion (SAO) stroke, and to evaluate their predictive value.

Methods

Clinical data were retrospectively collected from patients with anterior circulation SAO admitted to the Department of Neurology, Zhejiang Hospital between July 1, 2023 and February 28, 2025. Based on the modified Rankin Scale (mRS) score at 3 months after stroke onset, patients were divided into a poor-prognosis group (mRS≥2, n=38) and a good-prognosis group (mRS＜2, n=112). Baseline clinical characteristics, physiological parameters, laboratory indices, and TCD parameters were compared between the two groups. Spearman correlation analysis was used to assess associations between relevant variables and 3-month mRS scores. Multivariate logistic regression analysis was performed to identify independent predictors of poor 3-month outcome. Subgroup analysis, interaction analysis, and receiver operating characteristic (ROC) curve analysis were further conducted to evaluate the predictive performance of ipsilateral peak systolic velocity (PSV).

Results

Ipsilateral PSV, ipsilateral mean flow velocity (MFV), ipsilateral resistance index (RI), contralateral PSV, and contralateral MFV were all significantly higher in the poor-prognosis group than in the good-prognosis group (all P＜0.05). Multivariate logistic regression analysis demonstrated that ipsilateral PSV was an independent predictor of poor 3-month outcome in patients with anterior circulation SAO (odds ratio=1.066, 95% confidence interval [CI]: 1.039–1.094, P＜0.001). Interaction analysis revealed a significant interaction between ipsilateral PSV and infarct location (P=0.042), and a borderline significant interaction between ipsilateral PSV and anterior circulation-related mild intracranial large-artery stenosis (P=0.050). ROC curve analysis showed that the area under the curve of ipsilateral PSV for predicting poor 3-month outcome in the overall population was 0.830 (95%CI: 0.734–0.926, P＜0.001).

Conclusion

Ipsilateral PSV was independently associated with poor 3-month outcome in patients with anterior circulation SAO and may serve as a useful marker for predicting short-term prognosis. This association may vary across different infarct locations. Additionally, ipsilateral PSV may function as an adjunctive marker for early risk stratification in this population.

Key words: Small artery occlusion stroke, Anterior circulation, Transcranial Doppler ultrasonography, Prognosis, Cerebral hemodynamics

Hui Guo, Qi Kong, Yun Cheng, Siran Zhang. Predictive value of transcranial Doppler hemodynamic parameters for short-term prognosis in patients with anterior circulation small artery occlusion stroke[J]. Chinese Journal of Medical Ultrasound (Electronic Edition), 2026, 23(03): 236-243.

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URL: https://chaosheng.cma-cmc.com.cn/EN/10.3877/cma.j.issn.1672-6448.2026.03.008

https://chaosheng.cma-cmc.com.cn/EN/Y2026/V23/I03/236

Figures/Tables 9

临床特征	对照组（112例）	病例组（38例）	统计值	P值
年龄（岁， $x ¯$ ±s）	59.20±12.58	61.39±10.50	t=-0.965	0.334
性别[男/女，例（%）]	76（67.9）/36（32.1）	28（73.7）/10（26.3）	χ²=0.220	0.639
吸烟史[有/无，例（%）]	51（45.5）/61（54.5）	18（47.4）/20（52.6）	χ²=0.012	0.913
饮酒史[有/无，例（%）]	35（31.3）/77（68.8）	15（39.5）/23（60.5）	χ²=0.533	0.465
高血压病史[有/无，例（%）]	61（54.5）/51（45.5）	26（68.4）/12（31.6）	χ²=1.729	0.188
糖尿病病史[有/无，例（%）]	20（17.9）/92（82.1）	11（28.9）/27（71.1）	χ²=1.505	0.220

临床特征	对照组（112例）	病例组（38例）	统计值	P值
年龄（岁， $x ¯$ ±s）	59.20±12.58	61.39±10.50	t=-0.965	0.334
性别[男/女，例（%）]	76（67.9）/36（32.1）	28（73.7）/10（26.3）	χ²=0.220	0.639
吸烟史[有/无，例（%）]	51（45.5）/61（54.5）	18（47.4）/20（52.6）	χ²=0.012	0.913
饮酒史[有/无，例（%）]	35（31.3）/77（68.8）	15（39.5）/23（60.5）	χ²=0.533	0.465
高血压病史[有/无，例（%）]	61（54.5）/51（45.5）	26（68.4）/12（31.6）	χ²=1.729	0.188
糖尿病病史[有/无，例（%）]	20（17.9）/92（82.1）	11（28.9）/27（71.1）	χ²=1.505	0.220

生理参数及实验室指标	对照组（112例）	病例组（38例）	Z值	P值
dSBPV（%）	0.09（0.08，0.10）	0.08（0.07，0.10）	-1.384	0.167
dDBPV（%）	0.12（0.10，0.14）	0.10（0.09，0.11）	-2.861	0.004
nSBPV（%）	0.09（0.07，0.10）	0.08（0.06，0.09）	-1.416	0.157
nDBPV（%）	0.12（0.09，0.15）	0.10（0.08，0.12）	-2.258	0.024
HF（ms²）	13.46（7.88，78.75）	11.47（7.85，47.00）	-0.459	0.647
LF（ms²）	19.55（13.28，77.45）	18.53（12.84，47.88）	-0.723	0.470
LF/HF	1.51（1.21，1.87）	1.56（1.16，1.86）	0.056	0.952
HbA1c（mmol/mol）	7.40（6.70，8.20）	7.90（7.10，9.40）	0.827	0.486
Hcy（μmol/L）	10.40（9.08，14.36）	11.56（8.67，14.09）	0.187	0.870
TC（mmol/L）	4.14（3.36，5.05）	4.81（3.67，5.57）	1.539	0.124
TG（mmol/L）	1.37（1.00，1.98）	1.82（1.20，2.71）	2.045	0.041

TCD参数	对照组（112例）	病例组（38例）	Z值	P值
患侧PSV（cm/s）	85.00（75.00，100.00）	106.00（94.00，124.00）	-5.274	＜0.001
患侧MFV（cm/s）	53.00（45.00，61.00）	63.50（56.50，73.75）	-4.321	＜0.001
患侧PI	1.01（0.89，1.10）	1.05（0.96，1.15）	-1.645	0.101
患侧RI	0.60（0.56，0.64）	0.63（0.61，0.67）	-2.141	0.032
健侧PSV（cm/s）	90.00（75.00，103.00）	103.00（91.00，112.75）	-2.802	0.005
健侧MFV（cm/s）	53.00（46.00，62.00）	61.00（53.25，73.75）	-2.571	0.010
健侧PI	1.01（0.89，1.10）	1.06（0.96，1.13）	-1.652	0.098
健侧RI	0.61（0.56，0.65）	0.63（0.59，0.66）	-1.538	0.124

TCD参数	Spearman 相关系数（rho）	P值
患侧PI	0.219	0.021
患侧RI	0.229	0.016
健侧PI	0.248	0.009
健侧RI	0.265	0.005
TG（mmol/L）	0.224	0.006

变量	β	SE	OR	95%CI	P值
患侧PSV(cm/s)	0.064	0.0131	1.066	（1.039~1.094）	＜0.001
TG(mmol/L)	0.508	0.316	1.662	（0.895~3.086）	0.108
年龄分组	0.398	0.587	1.489	（0.471~4.707）	0.498
性别	-0.155	0.667	0.856	（0.232~3.161）	0.815
高血压病史	0.529	0.637	1.697	（0.487~5.917）	0.407
糖尿病病史	-0.098	0.752	0.907	（0.207~3.938）	0.896
高脂血症史	-0.090	1.229	0.914	（0.082~10.169）	0.941

亚组类别	亚组	对照组患侧PSV	病例组患侧PSV	AUC	95%CI	P值
年龄分组	非老年组	86.00（75.00，100.00）	104.00（94.00，121.00）	0.752	0.594~0.910	＜0.001
年龄分组	老年组	84.00（76.00，103.00）	110.00（96.00，133.00）	0.762	0.621~0.903	0.036
危险因素负荷分组	低危险因素负荷组	84.50（75.00，95.50）	105.00（86.50，119.25）	0.747	0.629~0.866	0.005
危险因素负荷分组	高危险因素负荷组	85.00（74.50，109.00）	122.50（99.25，150.25）	0.779	0.556~1.000	0.003
狭窄分组	无前循环相关轻度狭窄组	85.00（75.00，101.00）	105.00（83.00，124.00）	0.707	0.575~0.838	0.010
狭窄分组	合并前循环相关轻度狭窄组	86.00（75.00，100.00）	104.00（94.00，121.00）	0.880	0.756~1.000	0.088
梗死部位分组	基底节区梗死	84.00（73.50，97.00）	107.50（83.50，122.50）	0.732	0.571~0.893	0.015
	侧脑室旁梗死	89.00（80.00，110.00）	107.00（100.00，142.50）	0.760	0.528~0.992	0.088
	丘脑梗死	84.00（75.00，95.00）	105.00（87.00，134.50）	0.776	0.601~0.950	0.015

交互项	P值
患侧PSV×前循环相关轻度狭窄分组	0.050
患侧PSV×梗死部位分组	0.042
患侧PSV×年龄分组	0.501
患侧PSV×危险因素负荷分组	0.954

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