No abstract

Background and Purpose-Sonothrombolysis is a new treatment approach in acute ischemic stroke. The results of a monocenter, randomized clinical study are presented. Methods-Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a 1.8-MHz Doppler ultrasound (US) probe or a control group. All underwent standard thrombolysis with intravenous recombinant tissue-type plasminogen activator. Results-Thirty-seven subjects were included; 19 subjects were treated in the target (US) group and 18 in the control (no-US) group, all with no residual flow in the middle cerebral artery main stem occlusion (Thrombolysis in Brain Ischemia recanalization grade 0). Compared with the no-US group, the US group showed greater improvement in National Institutes of Health Stroke Scale values at days 1 and 4 and a higher median Thrombolysis in Brain Ischemia grade 1 hour after recombinant tissue-type plasminogen activator initiation. Recanalization (complete or partial) after 1 hour occurred in 57.9% of the US group and 22.2% of the no-US group (Pϭ0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score Յ1 (none from the no-US group) and 8 had a Barthel Index Ն95 (none from the no US group; Pϭ0.106 and Pϭ0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group (Pϭ0.60). Conclusions-This small randomized study indicates a beneficial impact of transcranial ultrasound on recanalization and short-term outcome in subjects with middle cerebral artery main stem occlusion and recombinant tissue-type plasminogen activator treatment.

We studied the effect of transcranial 2 MHz Doppler ultrasound (US) on the recanalization and outcome of stroke patients suffering from acute middle cerebral artery occlusion. All patients underwent intravenous recombinant tissue-type plasminogen activator thrombolysis. Eleven patients were randomly selected for continuous US monitoring (C-US) over 1 hour; 14 patients were selected for the control group. The C-US group showed a higher grade of recanalization after 1 hour but also a higher number of intraparenchymal bleedings. Overall, a favorable functional outcome occurred more frequently in the C-US group (Barthel index, p = 0.037) after 3 months.

TCCS is a noninvasive bedside method that provides rapid and reliable data regarding stroke subtype and mechanism immediately after onset. Window failure is a serious limitation of this method.

It is well established from pediatric experience and animal experiments that intracerebral blood can be demonstrated by B-mode real-time duplex scanning. This has recently become feasible in adults as well. The present study investigated the changes in the sonographic appearance of intracerebral hematomas over the course of time. Starting in May 1991, 23 consecutive patients with intracerebral hematoma confirmed by computed tomography (21 spontaneous and 2 traumatic hematomas) were investigated within 1 year. They were monitored by repeated ultrasound scanning via the transtemporal approach. The sonographic appearance of the hematomas on B-mode scans and the angle-corrected blood flow velocity in the basal cerebral arteries were assessed. There was unequivocal localization of the hematoma in 18 patients (78%). In 3 cases (13%), an adequate acoustic window could not be found. One small intracerebral hemorrhage was overlooked, and one extensive hemorrhage in the basal ganglia was misdiagnosed as a lobar hematoma. There was an alteration of the appearance of the hematoma with time. This was divided into three sonographic stages (initial stage, days 1 to 5; intermediate stage, days 6 to 10; and capsular stage, from day 10). In 14 of the 20 patients with an appropriate acoustic bony echo window, the blood flow velocity in the middle cerebral artery could be measured; in 1 of these patients, the signs of increasing intracranial pressure were apparent from Doppler frequency spectrum. In 5 patients, the intracerebral hematoma could be imaged but not the ipsilateral middle cerebral artery. One female patient showed cerebral circulatory arrest at the time of examination, which took place within 24 hours after the onset of clinical symptoms. Most intracerebral hematomas in adults can be imaged in B-mode. Their sonographic appearance changes over the course of the disease. The advantages of this noninvasive method are its easy bedside operation and its suitability for follow-up; it is also less stressful than other imaging procedures. It yields a combination of structural and functional diagnostic information. In approximately 13% of the cases, the investigation was not feasible because of inadequate ultrasonic penetration of the intact skull.