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(Stroke. 2000;31:3079-a.)
© 2000 American Heart Association, Inc.

Letters to the Editor

High Rate of Complete Recanalization and Dramatic Clinical Recovery During tPA Infusion When Continuously Monitored With 2-MHz Transcranial Doppler Monitoring

Dr David Blacker, MB, BS

Senior Neurology Registrar, Sir Charles Gairdner Hospital, Verdun Street, Nedlands, Perth, Western Australia

Key Words: stroke, acute • thrombolysis • ultrasonography, Doppler, transcranial

To the Editor:

Alexandrov et al¹ raise a fascinating possibility in their paper on transcranial Doppler monitoring of recanalization during systemic tPA infusion in acute ischemic stroke. They postulate that ultrasonic energy focused on intracranial thrombus might facilitate thrombolysis. It is easy to imagine how an even more precise beam of energy could be directed at intracranial thrombus with the goal of clot dissolution; why not combine MR angiography with stereotactically delivered magnetic or radiation energy? Could this be a stroke treatment of the future, using technology that exists now?

References

1. Alexandrov AV, Demchuk AM, Felberg RA, Christou I, Barber PA, Burgin WS, Malkoff M, Wojner AW, Grotta JC. High rate of recanalization and dramatic clinical recovery during tPA infusion when continuously monitored with 2-MHz transcranial Doppler monitoring. Stroke.. 2000;31:610–614.[Abstract/Free Full Text]

Response

Andrei V. Alexandrov, MD

Stroke Program, University of Texas–Houston Medical School

I would like to thank Dr Blacker for his letter that highlights an intriguing possibility of using beams, waves, and fields of different physical nature to treat stroke. Indeed, the ideas of thrombolysis with ultrasound alone ^R1 or combined with a lytic drug^R2 have been expressed long ago and since confirmed by many in several in vitro and animal experiments. Technological advances in other areas broadened applications of magnetic resonance into the interventional arena: image guided tracking of vascular guidewires^R3 and better focusing of an electron beam therapy in terms of dose distribution in biological tissues ^R4 . Improvements in computer technology and development of portable high resolution diagnostic and interventional equipment can one day make these "Star-Trek" visions of future therapies a reality in the emergency rooms and physician offices.

A necessary step, however, has to cover this gap in time: demonstration of safety and efficacy. The first concern is that focusing on a clot any beam or field (that is . . . [Full Text of this Article]