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(Stroke. 2000;31:2342.)
© 2000 American Heart Association, Inc.

Original Contributions

DIAS I: Duplex-Sonographic Assessment of the Cerebrovascular Status in Acute Stroke

A Useful Tool for Future Stroke Trials

T. Gerriets, MD; T. Postert, MD; M. Goertler, MD; E. Stolz, MD; F. Schlachetzki, MD; U. Sliwka, MD; G. Seidel, MD; S. Weber, MD; M. Kaps, MD for the DIAS (Duplex Sonography in Acute Stroke) Study Group

From the Departments of Neurology, Justus Liebig-University Giessen (T.G., E.S., M.K.); St Josef Hospital, Ruhr University, Bochum (T.P.); University of Magdeburg (M.G.); University of Regensburg (F.S.); University of Jena (U.S.); and Medical University at Lübeck (G.S.); and Schering AG (S.W.), Berlin, Germany.

Correspondence and reprint requests to Prof Dr med M. Kaps, Am Steg 20, 35385 Giessen, Germany. E-mail Manfred.Kaps{at}Neuro.med.Uni-Giessen.de

Background and Purpose—A number of controlled trials have evaluated the benefit of intravenous thrombolysis in acute stroke with inconsistent results. None of these studies assessed the initial vascular status or provided information regarding the recanalization rate after therapy. Further trials need to clarify whether certain subgroups might possibly benefit more than others from intravenous thrombolysis. Therefore, a fast and valid method for assessment of cerebrovascular status is needed. In this multicenter study, we evaluated the potentials and limitations of color-coded duplex sonography (TCCS) for cerebrovascular status assessment in acute stroke patients before and after therapy. Furthermore, we compared the recanalization rate for patients referred to thrombolytic and conservative medical therapy.

Methods—Fifty-eight patients suffering from hemispheric stroke were enrolled consecutively in 8 centers. Duplex sonography was performed on admission, 2 hours after start of therapy, and 24 hours after onset of symptoms. Therapy was started within 6 hours.

Results—Intravenous thrombolysis was performed in 18 patients, conservative medical therapy in 39 patients, and early thromboendarterectomy in 1 patient. The middle cerebral artery (MCA) mainstem was patent in 29 patients (53.7%), occluded in 25 (46.3%), and was not assessable in 4 patients. Recanalization of the occluded MCA after 2 and 24 hours was diagnosed in 50% and 78% of the patients treated with rtPA and in 0% and 8% in the conservatively treated patients.

Conclusions—Intravenous thrombolysis is highly effective in restoring blood flow after MCA occlusion. TCCS is suitable for assessment of the cerebrovascular status in acute stroke and therefore might define therapeutically relevant subgroups of patients in future stroke trials on the basis of their vascular pathology.

Key Words: cerebral arteries • diagnostic imaging • thrombolysis • ultrasonography, Doppler, duplex

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