Evaluation of very early recanalization after tPA administration monitoring by transcranial color-coded sonography

Abstract

Summary Background/aims Cerebrovascular ultrasonography was useful clinically for evaluating cerebral hemodynamics rapidly and in real-time for patients with acute ischemic stroke. We analyzed if the patients had early recanalization or not using transcranial color-coded sonography (TCCS) in order to evaluate the usefulness of real-time monitoring in systemic thrombolysis. Methods Subjects were patients who had acute ischemic stroke with intravenous tissue plasminogen activator (tPA) within 3 h from onset. We evaluated occlusion of intracranial arteries from transtemporal or suboccipital window by TC-CFI with Thrombolysis in Brain Ischemia (TIBI) flow-grading system and monitored residual flow in real-time every 15 min until 120 min after the t-PA bolus. Results We could monitor residual flow in 5 patients who had good echo windows (4 male, mean age; 60.8 ± 6.4 years). Two patients had proximal occlusion of the middle cerebral artery (MCA), one patient had distal occlusion of MCA, one patient had M2 occlusion and one patient had distal occlusion of unilateral vertebral artery. Four patients had early complete recanalization within 60 min after the t-PA bolus (two patients within 60 min and other two patients within 30 min), however, occlusion persisted during 120 min monitoring in one patient with proximal occlusion of MCA. NIH Stroke Scale of two patients with very early recanalization was 0 at the end of the treatment. There was no symptomatic and asymptomatic intracranial hemorrhage in 4 patients except for the patients without recanalization. Conclusions It is anticipated that real-time ultrasound monitoring is useful for evaluating a very early thrombolytic effect of tPA connected with early clinical recovery.