High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler Monitoring
- 1 March 2000
- journal article
- clinical trial
- Published by Ovid Technologies (Wolters Kluwer Health) in Stroke
- Vol. 31 (3), 610-614
- https://doi.org/10.1161/01.str.31.3.610
Abstract
Background and Purpose —Clot dissolution with tissue plasminogen activator (tPA) can lead to early clinical recovery after stroke. Transcranial Doppler (TCD) with low MHz frequency can determine arterial occlusion and monitor recanalization and may potentiate thrombolysis. Methods —Stroke patients receiving intravenous tPA were monitored during infusion with portable TCD (Multigon 500M; DWL MultiDop-T) and headframe (Marc series; Spencer Technologies). Residual flow signals were obtained from the clot location identified by TCD. National Institutes of Health Stroke Scale (NIHSS) scores were obtained before and after tPA infusion. Results —Forty patients were studied (mean age 70±16 years, baseline NIHSS score 18.6±6.2, tPA bolus at 132±54 minutes from symptom onset). TCD monitoring started at 125±52 minutes and continued for the duration of tPA infusion. The middle cerebral artery was occluded in 30 patients, the internal carotid artery was occluded in 11 patients, the basilar artery was occluded in 3 patients, and occlusions were multiple in 7 patients; 4 patients had no windows; and 1 patient had a normal TCD. Recanalization on TCD was found at 45±20 minutes after tPA bolus: recanalization was complete in 12 (30%) and partial in 16 (40%) patients. Dramatic recovery during tPA infusion (total NIHSS score P ≤0.01). Improvement by ≥10 NIHSS points or complete recovery was found in 30% of all patients at the end of tPA infusion and in 40% at 24 hours. Improvement by ≥4 NIHSS points was found in 62.5% of patients at 24 hours. Conclusions —Dramatic recovery during tPA therapy occurred in 20% of all patients when infusion was continuously monitored with TCD. Recovery was associated with recanalization on TCD, whereas no early improvement indicated persistent occlusion or reocclusion. At 24 hours, 40% of all patients improved by ≥10 NIHSS points or recovered completely. Ultrasonic energy transmission by TCD monitoring may expose more clot surface to tPA and facilitate thrombolysis and deserves a controlled trial as a way to potentiate the effect of tPA therapy.Keywords
This publication has 11 references indexed in Scilit:
- Clinical Recovery from Acute Ischemic Stroke after Early Reperfusion of the Brain with Intravenous ThrombolysisNew England Journal of Medicine, 1999
- Low-frequency, low-intensity ultrasound accelerates thrombolysis through the skullJapanese Journal of Clinical Oncology, 1999
- Tissue at Risk of Infarction Rescued by Early Reperfusion: A Positron Emission Tomography Study in Systemic Recombinant Tissue Plasminogen Activator Thrombolysis of Acute StrokeJournal of Cerebral Blood Flow & Metabolism, 1998
- Low-frequency Ultrasound Penetrates the Cranium and Enhances Thrombolysis In VitroNeurosurgery, 1998
- Myths regarding the NINDS rt-PA Stroke Trial: setting the record straight.Annals of Emergency Medicine, 1997
- Tissue Plasminogen Activator for Acute Ischemic StrokeNew England Journal of Medicine, 1995
- Evaluation of the Thrombolytic Effect of Tissue-Type Plasminogen Activator with Ultrasonic Irradiation: In Vitro Experiment Involving Assay of the Fibrin Degradation Products from the Clot.Biological & Pharmaceutical Bulletin, 1994
- Recombinant tissue plasminogen activator in acute thrombotic and embolic strokeAnnals of Neurology, 1992
- Type and extent of hemispheric brain infarctions and clinical outcome in early and delayed middle cerebral artery recanalizationNeurology, 1992
- Clinical and instrumental evaluation of patients with ischemic stroke within the first six hoursJournal of the Neurological Sciences, 1989