Comparative study of transcranial Doppler ultrasonography and magnetic resonance angiography on recanalization of intravenous thrombolysis with alteplase in acute ischemic stroke patients

Abstract

Objective To evaluate the accuracy and clinical diagnostic values of thrombolysis in brain ischemia (TIBI) grade system of transcranial Doppler ultrasomography (TCD) in assessing the situation of recanalization after thrombolytic therapy with modified thrombolysis in cerebral infarction (m-TICI) grade system of MRA as reference. Methods Select 61 acute ischemic stroke patients with middle cerebral artery (MCA), basilar artery (BA) stenosis or occlusion receiving thrombolytic therapy with alteplase. The patients underwent MRA and TCD examination before and after 24 h thrombolysis. Use m-TICI and TIBI grade system to evaluate the rate of occlusion and recanalization of target artery and test the consistency of two systems on recanalization evaluation. Results Before thrombolytic therapy, m-TICI grade showed artery occlusion in 49 cases (80.33% ) and TIBI grade displayed artery occlusion in 45 cases (73.77% ), indicating high consistency statistically (κ = 0.816, P = 0.000). Twenty-four hours after thrombolytic therapy, m-TICI and TIBI grade showed complete recanalization in 9 cases (14.75%) and 11 cases (18.03%), partial recanalization in 18 cases (29.51% ) and 17 cases (27.87% ) respectively, showing high statistical consistency. The comprehensive evaluation of m-TICI and TIBI grade system revealed total recanalization in 27 cases (44.26%) and 28 cases (45.90%), showing high statistical consistency (κ = 0.917, P = 0.000). Conclusion The TIBI grade system of TCD has high consistency in diagnosing artery stenosis or occlusion and evaluating vascular recanalization in acute ischemic stroke patients with thrombolytic therapy compared with m-TICI grade system of MRA examination. TCD examination is flexible, convenient, economical, repeatable and can give bedside long monitoring, so it is worthy of further in-depth research, in order to promote its application in thrombolytic treatment process. doi：10.3969/j.issn.1672-6731.2013.12.010