Doppler ultrasound and clinical findings in patients with acute ischemic stroke treated with intravenous thrombolysis.
The aim of this study was to assess cerebral hemodynamics in patients with acute ischemic stroke undergoing thrombolytic therapy and to assess the relationship between cerebral hemodynamics and outcome. Forty-one unselected patients admitted to hospital within 3 h received intravenous thrombolytic therapy and were examined by extracranial and transcranial Doppler ultrasound examinations. Their strokes were clinically graded with the National Institute of Health Stroke Scale. Outcome after 3 months was graded with the modified Rankin Scale. Amongst the 27 patients who had an additional ultrasound examination 24 h after treatment, favorable outcome was significantly more common amongst patients with recanalization than amongst those without (P < 0.004). Thirteen patients with middle cerebral artery occlusions were continuously monitored during thrombolysis and frequently up to 5 h after start of thrombolysis. Early recanalization occurred in nine (69%), at a median delay of 178 min (range 140-287) after stroke onset. All of these nine patients had a favorable outcome. Recanalization within 24 h was associated with favorable outcome. Subgroup analysis suggests that this effect is mostly related to early recanalization within the first 5 h after stroke. Transcranial Doppler may therefore help to identify those patients most probably to benefit from thrombolysis, especially in those patients with a higher potential risk of complications.
Thomassen
L
L
Department of Neurology, Haukeland University Hospital, Bergen, Norway. lars.thomassen@haukeland.no
Waje-Andreassen
U
U
Naess
H
H
Aarseth
J
J
Russell
D
D
D003131:Combined Modality Therapy; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D007262:Infusions, Intravenous / Q000379:methods; D002546:Ischemic Attack, Transient / Q000000981:diagnostic imaging / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy; D017585:Ultrasonography, Doppler, Transcranial / Q000379:methods*
D010959:Tissue Plasminogen Activator