[TCD monitoring during intravenous administration of recombinant tissue plasminogen activator]

Our aim is to investigate the utility of transcranial Doppler (TCD) monitoring during intravenous administration of 0.6 mg/kg recombinant tissue plasminogen activator (IV rt-PA) which is governmental approved in Japan. Acute ischemic stroke patients with M1 portion of the middle cerebral artery (M1) occlusion treated with IV rt-PA were prospectively enrolled. M1 occlusion was diagnosed before IV rt-PA using magnetic resonance angiography (MRA). Patients without sufficient temporal window of TCD were excluded. TCD monitoring was conducted for 1 hour (h) during IV rt-PA. Recanalization on TCD was defined using thrombolysis in brain ischemia (TIBI) flow grades. After all patients were classified into two groups according to the presence of TCD recanalization (TCD recanalization and TCD non-recanalization group), three-month patients outcome, recanalization rate on MRA 1 h of IV rt-PA, and symptomatic cerebral hemorrhage within 24 h were compared between two groups. We enrolled 16 patients. Eight patients (50%, 7 men [88%]; age, 70 years [interquartile range. 55-81]; NIHSS score, 18 [12-22]) were in the TCD recanalization group and 8 (50%, 6 men [75%]; age, 72 years [62-79]; NIHSS score 19 [15-23] were in the TCD non-recanalization group. Symptomatic cerebral hemorrhage was not seen in both groups at all. MRA 1 h of IV rt-PA revealed recanalization in all 8 (100%) patients with TCD recanalization group and 2 (25%) with TCD non-recanalization group (agreement, 88%; and kappa value, 0.75, P = 0.002). At three months, 5 (63%) of 8 patients in the TCD recanalization group had favorable outcome, and 0 (0%) of 8 in the TCD non-recanalization group (P = 0.026). TCD monitoring for 1 h during IV rt-PA can diagnose the recanalization based on MRA. TCD monitoring should predict good clinical outcome at three months.