Assessment of cerebral hemodynamics in patients with acute stroke and transient ischemic attack with different etiopathogenesis

Background and aims: we aimed to explore the cerebral hemodynamics in acute Stroke/TIA patients and assess if it may represent a prognostic marker of clinical and cognitive outcome. Methods: patients with TIA/non disabling stroke of anterior circulation were enrolled. Stroke etiopathogenesis was defined according to clinical guidelines. The observation period of 12 months included 4 assessments: T1 (48-72h from onset), T2 (1 month follow up [FU]), T3 (6 months FU) and T4 (12 months FU). Clinical scales and cognitive tests were performed every time (T1-T4), whereas vasomotor reactivity (VMR) and Pulsatility Index (PI) of MCA and PCA were registered at T1 and T3. Results: 124 patients with acute non disabling stroke/TIA and a median age of 66 (54.75-74.25) years were enrolled. 71% were men and 69,4% had a stroke. At T1, we found an inverse correlation between MCA PI and MMSE (p<0.0001) and MOCA (p=0.001) and between PCA PI and MMSE (p=0.004) and MOCA (p=0.003). A positive correlation was found between age and MCA PI (p<0.0001) and PCA PI (p<0.0001), while an inverse correlation was registered between age and MMSE (p<0.0001) and MOCA (p<0.0001). The same results were confirmed at T3. An inverse correlation was found between MCA PI at baseline and MOCA at T2 (p=0.001), MMSE (p=0.014) and MOCA (p=0.001) at T3, MMSE (p=0.005) and MOCA (p=0.003) at T4. An inverse correlation was registered between baseline PCA PI and MMSE (p=0.003) and MOCA (p=0.004) at T2, MMSE (p=0.027) and MOCA (p=0.003) at T3, MOCA at T4 (p=0.020). A positive correlation was observed between baseline MCA PI and mRS at T2 (p=0.025), T3 (p=0.003) and T4 (p=0.001). We also performed a multi-regression analysis to explore the effect of all the vascular risk factors on PI at baseline. We found that age and diabetes were the main risk factors influencing MCA PI at T1 (p<0.0001) and that age was the only factor influencing PCA PI at T1 (p<0.0001). PI at T1 did not differ between stroke subtypes and did not change from T1 to T3. VMR at T1 did not differ between stroke subtypes and was higher than T3. Conclusion: our findings suggest that a higher PI of MCA and PCA is a prognostic marker of worst cognitive and clinical outcome in patients with ischemic non disabling stroke and TIA.