Acute ischemic stroke (AIS) affects approximately 13.7 million people, with a mortality rate of approximately 5.5 million annually, making it the second leading cause of death worldwide. Of all strokes, 62.4% are ischemic, the prevalence of which has increased significantly over the past 30 years, primarily due to improved diagnostic capabilities [Kuriakose D., 2020]. A total of 460 patients with acute ischemic stroke (AIS) were examined after systemic thrombolytic therapy (TLT), thrombextraction (TE), a combination of TLT with TE, and TLT with stenting on days 1, 3, and 7 after reperfusion. Of these, 210 (45.6%) were men and 250 (54.4%) were women. The age ranged from 23 to 97 years (mean age 69 years). Patients with temporal ultrasonic windows impenetrable for ultrasound were excluded from the analysis.

Exclusion criteria:the presence of primary cerebral hemorrhage, cerebral aneurysms, and arteriovenous malformations. The following reperfusion methods were used: TLT (263 patients), TE (87 patients), a combination of TLT and TE (91 patients), and TE with stenting (19 patients).  A decrease in the peak systolic velocities (PSV) and an increase in the resistive (RI) and pulsativity indexes (PI) were observed in the ipsilateral common carotidartery (CCA) on the infarction-associated middle cerebral artery (MCA). The average (PSV) was 54.7 ± 6.2 cm/s, the mean end diastolic velocitiy (EDV) was 14.2 ± 3.6 cm/s, the RI was 0.75 ± 0.05, and the PI was 1.64 ± 0.11. All hemodynamic parameters in the infarctionassociated MCA differed significantly compared to the contralateral side. Significant differences in hemodynamic parameters (PSV and RI) on admission to the hospital were found between patients with favorable and unfavorable functional outcomes, assessed using the Rankin Scale (mRS).

After 7 days after reperfusion, 150 (32.6%) patients had an unfavorable functional outcome (mRS> 2), a good functional outcome (mRS<2) – in 310 (67.4%) patients. Hemodynamic parameters in patients with a poor outcome at 7 days post treatment did not differ significantly from those at admission. In contrast, patients with a good outcome showed a significant improvement in blood flow parameters (какие?) compared to those at admission. The increase in PSV averaged 50–60% of baseline values. Significant differences in time average maximal velocity (TAMX) were found between patients with a favorable and unfavorable early outcome at discharge. A total of 176 patients (38.3%) had an unfavorable functional outcome (mRS>2): 175 (66.5%) in  the TLT group and 1 patient (0.5% of the invasive treatment groups) in the invasive treatment groups. A good functional outcome (mRS<2) was observed in 284 (61.7%) patients: 88 (33.5%) in the TLT group and 196 (99.5%) in the invasive treatment groups. A fatal outcome was recorded in 97 (21.1%) cases.

Hemodynamic parameters in cases of an unfavorable outcome in the early period did not differ from the results at admission. In patients with a good outcome, a significant improvement in intracranial blood flow parameters was observed compared with the results at admission: among individuals with a favorable functional outcome, TAMX in the MCA increased by an average of 50% compared with baseline values, in the anterior cerebral artery (ACA) and posterior cerebral artery (PCA) - by 60%, in the vertebral artery (VA) and basilar artery (BA) - by 40%. So, patients with AIS are likely to have decreased PSV an increased RI and PI in unilateral CCA. The increase of TAMX in MCA by 50%, in PCA and ACA – in 60%, in VA and BA by 40% were associated with favorable functional outcome, more often in in the invasive treatment groups. No changes in cerebral hemodynamics correlated with fatal outcome. 

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