High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler Monitoring

• DOI: 10.1161/01.str.31.3.610
• Publication Date: 2011-06-17T20:10:52Z
• Authors: Andrei V. Alexandrov; Andrew M. Demchuk; Robert A. Felberg; Ioannis Christou; Philip A. Barber; W. Scott Burgin; Marc Malkoff; Anne W. Wojner; James C. Grotta
• Keywords: Transcranial Doppler; Bolus (digestion); Stroke; Fibrinolytic agent

Background and Purpose —Clot dissolution with tissue plasminogen activator (tPA) can lead to early clinical recovery after stroke. Transcranial Doppler (TCD) low MHz frequency determine arterial occlusion monitor recanalization may potentiate thrombolysis. Methods —Stroke patients receiving intravenous tPA were monitored during infusion portable TCD (Multigon 500M; DWL MultiDop-T) headframe (Marc series; Spencer Technologies). Residual flow signals obtained from the clot location identified by TCD. National Institutes of Health Stroke Scale (NIHSS) scores before infusion. Results —Forty studied (mean age 70±16 years, baseline NIHSS score 18.6±6.2, bolus at 132±54 minutes symptom onset). monitoring started 125±52 continued for duration The middle cerebral artery was occluded in 30 patients, internal carotid 11 basilar 3 occlusions multiple 7 patients; 4 had no windows; 1 patient a normal Recanalization on found 45±20 bolus: complete 12 (30%) partial 16 (40%) patients. Dramatic (total <3) occurred 8 (20%) all (baseline range 6 22; recanalization). Lack improvement or worsening associated recanalization, late reocclusion (C=0.811, P ≤0.01). Improvement ≥10 points 30% end 40% 24 hours. ≥4 62.5% Conclusions —Dramatic therapy 20% when continuously Recovery TCD, whereas indicated persistent reocclusion. At hours, improved recovered completely. Ultrasonic energy transmission expose more surface facilitate thrombolysis deserves controlled trial as way effect therapy.