Clinical and Sonographic Patterns of Tandem Internal Carotid Artery/Middle Cerebral Artery Occlusion in Tissue Plasminogen Activator–Treated Patients

• DOI: 10.1161/hs0102.101892
• Publication Date: 2002-07-28T23:16:47Z
• Authors: Ashraf El-Mitwalli; Mohamed Saad; Ioannis Christou; Marc Malkoff; Andrei V. Alexandrov
• Keywords: Stroke; Transcranial Doppler; Collateral circulation

Background and Purpose — The National Institutes of Health Stroke Scale (NIHSS) is predictive thrombus presence but has limited ability to identify occlusion location in the anterior circulation. We describe clinical sonographic patterns that are associated with tandem internal carotid artery (ICA) middle cerebral (MCA) occlusions. Methods Consecutive acute ischemic stroke patients receiving intravenous tissue plasminogen activator (TPA) were studied. Pretreatment NIHSS scores bedside transcranial Doppler (TCD) obtained for all patients. Results A total 95 treated TPA at 132±60 minutes from onset On TCD, 48 had isolated MCA (mean 16.8±5.8, median 17, range 5 28); 16 ICA/MCA 18.8±5.8, 22, 8 29; P =NS). In groups, 19% 11%, respectively, <12 points. Compared hemiplegia, forced gaze deviation, complete neglect, lower attributable partial arm and/or leg paresis, preference, neglect. those patients, TCD showed ≥2 major collateral channels low-resistance flow M1 origin, suggesting perfusion perforating arteries. Although cannot differentiate between high-grade ICA stenosis or occlusion, stenotic signals terminal differentiated lesions ( <0.01). Conclusions Tandem was found on 17% TPA-treated similar Lower seen a higher number Thrombolysis Brain Ischemia (TIBI) grades origin.