Association of transcranial Doppler and carotid ultrasound parameters with swallowing outcomes after endovascular thrombectomy for anterior circulation stroke.

BACKGROUND: Post-stroke dysphagia (PSD) remains prevalent after anterior circulation stroke treated with endovascular thrombectomy (EVT). We evaluated associations between ultrasound-derived hemodynamic indices and swallowing outcomes and their incremental prognostic value beyond clinical factors. METHODS: This retrospective cohort included 169 adults with anterior circulation stroke treated with EVT between November 2018 and November 2023. Transcranial Doppler and carotid ultrasonography measured intracranial pulsatility index (PI) and extracranial resistive index (RI). Outcomes included nasogastric (NG) tube dependence and Functional Oral Intake Scale (FOIS) at 4 and 12 weeks. RESULTS: Several RI and PI measures were associated with swallowing outcomes in univariable analyses. Basilar artery (BA) PI showed a weak correlation with time to NG tube removal (r = 0.160, p = 0.044). After adjustment for age, initial National Institutes of Health Stroke Scale (NIHSS), and 3-step swallowing screening, BA PI was not significantly associated with NG tube dependence at 4 weeks or 12 weeks (p = 0.134 and p = 0.064) and did not improve model discrimination (DeLong p = 0.281 and p = 0.362). CONCLUSIONS: Ultrasound-derived hemodynamic parameters were associated with swallowing outcomes after EVT, but the incremental prognostic value of BA PI beyond clinical factors was limited and requires prospective validation.