Site of Arterial Occlusion Identified by Transcranial Doppler Predicts the Response to Intravenous Thrombolysis for Stroke

Abstract

Background and Purpose-The objective of this study was to examine clinical outcomes and recanalization rates in a multicenter cohort of stroke patients receiving intravenous tissue plasminogen activator by site of occlusion localized with bedside transcranial Doppler. Angiographic studies with intraarterial thrombolysis suggest more proximal occlusions carry greater thrombus burden and benefit less from local therapy. Methods-Using validated transcranial Doppler criteria for specific arterial occlusion (Thrombolysis in Brain Ischemia flow grades), we compared the rate of dramatic recovery (National Institutes of Health Stroke Scale score Յ2 at 24 hours) and favorable outcomes at 3 months (modified Rankin Scale Յ1) for each occlusion site. We determined the likelihood of recanalization at various occlusion sites and its predictors. Then, stepwise logistic regression was used to determine predictors of complete recanalization. Results-Three hundred thirty-five patients had a mean age 69Ϯ13 years and 48.5% were women (median baseline National

Treatment of acute stroke: a misconception

“…The same group confirmed earlier observations that an occlusion of the distal internal carotid artery can hardly recanalized with I.V. TPA [14,15]. Another group showed that the effect of I.V.…”

Intra-arterial Therapy for Acute Ischemic Stroke

“…Although intravenous (IV) thrombolysis with tissue plasminogen activator (tPA) has been approved by the Food and Drug Administration (FDA) since 1996, it has been used in only 3 to 4% of ischemic stroke patients due to major limitations and a narrow 3-to 4.5-h treatment window [1,2]. The benefit of IV tPA is limited, both in regard to clinical and recanalization efficacy, particularly for large vessel occlusions, the most common cause of severe and fatal AIS [3,4]. Large vessel occlusions are however amenable to endovascular therapy, not unlike acute coronary syndromes presenting as ST segment elevation myocardial infarction, which are better treated with percutaneous interventions rather than IV thrombolysis [5].…”

Approach to and management of the acute stroke patient with atrial fibrillation: A literature review

“…21 According to more recent studies, ultrasound-enhanced thrombolysis may augment tissue plasminogen activator induced arterial recanalization by continuous transcranial Doppler. 22 Symptomatic hemorrhagic transformation of the infarction remains the primary concern with the administration of intravenous rtTPA. 23,24 Despite the apparent risks of ICH, atrial fibrillation patients not on warfarin should always be promptly referred for thrombolysis whenever they are eligible.…”