title: Use of emergency department transcranial Doppler assessment of reperfusion after intravenous tPA for ischemic stroke.
abstract: BACKGROUND
  Thrombolysis with intravenous recombinant tissue plasminogen activator (IV-tPA) has been associated with significant improvements in clinical outcomes when initiated within 3 h of symptom onset. Although adjunctive therapies for acute stroke have been developed, challenges remain in identifying appropriate patients and therapeutic end-point measurements.
  
  
  OBJECTIVE
  To describe the use of transcranial Doppler (TCD) monitoring in the Emergency Department (ED) to guide the decision for advanced reperfusion strategies after failure of IV-tPA.
  
  
  METHODS
  A 75-year-old man presented to the ED within 50 min after the acute onset of right-sided hemiparesis and aphasia. After administration of IV-tPA, there was no immediate improvement in neurological symptoms. TCD performed in the ED demonstrated persistent left middle cerebral artery (MCA) occlusion. Based on this information, the patient received intra-arterial tPA followed by mechanical thrombectomy of the MCA occlusion, resulting in clinical improvement of the patient's right hemiparesis and aphasia.
  
  
  CONCLUSIONS
  TCD is a feasible assessment tool for use in the ED to aid in diagnosis and to guide treatment decisions in patients with acute ischemic stroke, including those not responding to IV-tPA therapy.
authors.affiliation: Duke University School of Medicine, Duke University Medical Center, Durham, North Carolina, USA.
authors.forename: Samantha
authors.initials: S
authors.lastname: Phillips
authors.forename: Leanne
authors.initials: L
authors.lastname: Stanley
authors.forename: Heather
authors.initials: H
authors.lastname: Nicoletto
authors.forename: Marilyn
authors.initials: M
authors.lastname: Burkman
authors.forename: Daniel T
authors.initials: DT
authors.lastname: Laskowitz
authors.forename: Charles B
authors.initials: CB
authors.lastname: Cairns
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000188:drug therapy; D002560:Cerebrovascular Circulation; D004636:Emergency Service, Hospital; D005343:Fibrinolytic Agents / Q000008:administration & dosage; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging* / Q000188:drug therapy; D007261:Infusions, Intra-Arterial; D008297:Male; D015424:Reperfusion; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage; D017211:Treatment Failure; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator