My worst case with sonothrombolysis

Abstract

This article presents the case of a 63-year-old man with an acute ischemic stroke due to extracranial thrombosis of the left internal carotid artery, associated with about 70% stenoses of the right common and internal carotid arteries. The patient was treated with rtPA associated with a temporal transcranial ultrasound examination (TCCS) for an hour during a rtPA infusion. During the transcranial monitoring the left middle cerebral artery (LMCA) was rated between 2 and 3 on the TIBI scale. At the 24th hour two small ischemic zones and two intracranial hematomas were detected. No new symptoms were added. There are data showing that transcranial ultrasound monitoring (TCD and TCCS) and microbubble administration in acute ischemic stroke patients are associated with an early recanalization and a high rate of hemorrhagic transformation but do not seem to increase the risk of a symptomatic intracranial hemorrhage. According to CLOTBUST TCD alone is safe in acute ischemic stroke patients. TCCS alone is also tested in a smaller study. In the presented case report an association between the transtemporal insonation and the hematomas is possible but not probable.