Impact of Verticalization on Intracranial Hemodynamics Assessed in Transcranial Doppler at the Acute Phase of Cerebral Infarction

Fondation Ophtalmologique Adolphe de Rothschild36 enrolled

Overview

The management of patients with ischemic stroke or transient ischemic attack is based on the preservation of a brain area by maintaining sufficient intracranial hemodynamics (IH) and with rapid recanalization. The impact of the patient's position (supine or seated position) on the IH in the event of narrowing or occlusion of an artery is poorly assessed but may be of particular importance. Variations in blood flow according to the positioning of the patient's body are measurable using a transcranial Doppler. The main objective is to verify whether intracerebral hemodynamic changes during early verticalization after ischemic stroke or transient ischemic attack are more frequent in patients with carotid stenosis or occlusion compared to those without stenosis or occlusion.

Study Type

OBSERVATIONAL

Enrollment

Conditions

Stroke

Interventions

Transcranial DopplerOTHER

Initially, the patient will be placed in a strict supine position (at 0°) in his hospital bed in the USINV, according to the usual care. In a second step, the patient will be verticalized (from 0° to 90°). HI parameters in supine position and during verticalization will be recorded continuously by placing the transcranial Doppler helmet. After 15 minutes of recording, the patient will be placed back in supine position. The end of the patient's participation in the study will correspond to the removal of the helmet.

Eligibility

Sex: ALLMin age: 18 Years

Medical Language ↔ Plain English

Inclusion Criteria: * Ischemic stroke (AIC) or transient ischemic attack (AIT) of the carotid artery * Duration of symptoms less than 48 hours * Absence of homolateral or downstream intracranial stenosis or occlusion M1 * Lifting authorized by the referent clinician. * Rankin's score before AIC/AIT ≤ 2 • For cases: * Carotid stenosis of more than 50% NASCET (North American Symptomatic Carotid Endarterectomy Trial) or an occlusion • For controls: * Absence of carotid stenosis greater than 50% NASCET (North American Symptomatic Carotid Endarterectomy Trial) or occlusion Exclusion Criteria: \- Disrupted vigilance Secondary exclusion criteria: * Absence of a homolateral temporal acoustic window at the lesion * Impossibility to verticalize the patient

Outcomes

Primary Outcomes

Percentage of patients with a change in mean cerebral artery velocity (MCAVM) in transcranial Doppler

Percentage of patients with a change in mean cerebral artery velocity (MCAVM) in transcranial Doppler (defined by a variation of more than 10%) on the symptomatic side evaluated in transcranial Doppler when changing from the lying position (0°) to the 90° position (measured 2 minutes after verticalization).

Time frame: 2 minutes