(Stroke. 2000;31:1128.)
© 2000 American Heart Association, Inc.
Original Contributions |
Transcranial Doppler Ultrasound Criteria for Recanalization After Thrombolysis for Middle Cerebral Artery Stroke
From the Stroke Treatment Team, University of Texas–Houston Medical School.
Correspondence to Dr A. Alexandrov, Department of Neurology, University of Texas–Houston Medical School, 6431 Fannin, MSB 7.044, Houston, TX 77030. E-mail avalexandrov{at}worldnet.att.net
Background and Purpose—Transcranial Doppler (TCD) can demonstrate arterial occlusion and subsequent recanalization in acute ischemic stroke patients treated with intravenous tissue plasminogen activator (tPA). Limited data exist to assess the accuracy of recanalization by TCD criteria.
Methods—In patients with acute middle cerebral artery (MCA) occlusion treated with intravenous tPA, we compared posttreatment TCD with angiography (digital subtraction or magnetic resonance). On TCD, complete occlusion was defined by absent or minimal signals, partial occlusion by blunted or dampened signals, and recanalization by normal or stenotic signals. Angiography was evaluated with the Thrombolysis In Myocardial Ischemia (TIMI) grading scale.
Results—Twenty-five patients were studied (age 61±18 years, 16
men and 9 women). TCD was performed at 12±16 hours and angiography at
41±57 hours after stroke onset, with 52% of studies performed within
3 hours of each other. Recanalization on TCD had
the following accuracy parameters compared with
angiography: sensitivity 91%, specificity 93%, positive predictive
value (PPV) 91%, and negative predictive value (NPV) 93%. To predict
partial occlusion (TIMI grade II), TCD had sensitivity of 100%,
specificity of 76%, PPV of 44%, and NPV of 100%. TCD predicted the
presence of complete occlusion on angiography (TIMI grade 0 or I) with
sensitivity of 50%, specificity of 100%, PPV of 100%, and NPV of
75%. TCD flow signals correlated with angiographic patency
(
2=24.2, P<0.001).
Conclusions—Complete MCA recanalization on TCD accurately predicts angiographic findings. Although a return to normal flow dynamics on TCD was associated with complete angiographic resumption of flow, partial signal improvement on TCD corresponded with persistent occlusion on angiography.
Key Words: angiography • recanalization • thrombolysis • ultrasonography
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