High Rate of Recanalization of Middle Cerebral Artery Occlusion During 2-MHz Transcranial Color-Coded Doppler Continuous Monitoring Without Thrombolytic Drug

Abstract

Background and Purpose— Experimental evidence indicates that ultrasound can accelerate thrombolysis. We report our findings on early recanalization during transcranial color-coded Doppler (TCCD) continuous monitoring in acute stroke patients with middle cerebral artery (MCA) main stem occlusion. Methods— We performed continuous TCCD monitorings in 6 consecutive patients with acute MCA main stem occlusion using a 2-MHz transducer. Patients were not treated with recombinant tissue plasminogen activator. Results— Partial recanalization, defined as blunted waveforms, occurred during monitoring in 5 patients (83%). The mean time to beginning of recanalization was 17.2±9.6 minutes. Complete recanalization at 24 hours occurred in only 1 patient. The mean National Institutes of Health Stroke Scale score in the patients who recanalized during monitoring was 21.2±4.1 at baseline, 19.2±5 at 2 hours, and 15.6±3.4 at 24 hours ( P =0.1). Conclusions— In this short series of patients with acute MCA main stem occlusion, not treated with recombinant tissue plasminogen activator, we found a high rate of early partial recanalization during continuous exposure to 2-MHz ultrasound.

Ultrasound Accelerates Thrombolysis of Acutely Induced Platelet-Rich Thrombi Similar to Those in Acute Myocardial Infarction

“…[32][33][34] On the other hand, 1 clinical study of the efficacy of sonothrombolysis in AMI found that TIMI grade 3 flow was achieved in only 64% of patients treated with both US and a fibrinolytic agent, 35 which is approximately the same rate previously reported for pharmacological thrombolysis without US. [5][6][7][8] The reason why clinical findings show US to be promising for potentiation of thrombolysis in stroke but not AMI is unclear at present.…”

Neurosonological Evaluation of the Acute Stroke Patients

“…The CLOTBUST study (Alexandrov et al 2004b) evaluated the combined effect of rtPA administration within 3 h from symptom onset and TCD continuous monitoring at 2 MHz (diagnostic parameters), achieving a recanalization rate of 36% and an hemorrhagic transformation rate of 9%, not significantly different in comparison with the hemorrhagic rate of non-monitored patients. Other authors used TCCS for the same purposes with a diagnostic setting, with or without rtPA administration, confirming these findings (Cintas et al 2002;Eggers et al 2008). The data about ultrasound-enhanced thrombolysis has been recently analysed in a metaanalysis ) and the results were comforting, regarding the safety of sonothrombolysis with high frequency ultrasounds, with or without UCA.…”

Is Mechanical Clot Removal or Disruption a Cost-Effective Treatment for Acute Stroke?

“…14 Spontaneous recanalization is poorly documented in the literature and will depend on the selection of subjects studied and the timing of evaluation, as seen in the small number of published studies. 21,[24][25][26][27] However, the recanalization rate with medical therapy would have to be quite high to change the study results, and the highest rate of recanalization with medical therapy previously reported was 50%. 21 On the other hand, a lower recanalization rate with NIR treatment, below 67%, could render the intervention non-cost-effective.…”

“…Symptomatic ICH was not always reported in the literature and often was not specific for recanalization status. 15,[26][27][28] The Multi MERCI single-arm trial collected data on recanalization and ICH rates; however, the number of subjects in each group was small. The number of disabled survivors may be underestimated.…”