Use of emergency department transcranial Doppler assessment of reperfusion after intravenous tPA for ischemic stroke.

Journal Article (Journal Article)

BACKGROUND: Thrombolysis with intravenous recombinant tissue plasminogen activator (IV-tPA) has been associated with significant improvements in clinical outcomes when initiated within 3 h of symptom onset. Although adjunctive therapies for acute stroke have been developed, challenges remain in identifying appropriate patients and therapeutic end-point measurements. OBJECTIVE: To describe the use of transcranial Doppler (TCD) monitoring in the Emergency Department (ED) to guide the decision for advanced reperfusion strategies after failure of IV-tPA. CASE REPORT: A 75-year-old man presented to the ED within 50 min after the acute onset of right-sided hemiparesis and aphasia. After administration of IV-tPA, there was no immediate improvement in neurological symptoms. TCD performed in the ED demonstrated persistent left middle cerebral artery (MCA) occlusion. Based on this information, the patient received intra-arterial tPA followed by mechanical thrombectomy of the MCA occlusion, resulting in clinical improvement of the patient's right hemiparesis and aphasia. CONCLUSION: TCD is a feasible assessment tool for use in the ED to aid in diagnosis and to guide treatment decisions in patients with acute ischemic stroke, including those not responding to IV-tPA therapy.

Full Text

Duke Authors

Cited Authors

  • Phillips, S; Stanley, L; Nicoletto, H; Burkman, M; Laskowitz, DT; Cairns, CB

Published Date

  • January 2012

Published In

Volume / Issue

  • 42 / 1

Start / End Page

  • 40 - 43

PubMed ID

  • 19111426

International Standard Serial Number (ISSN)

  • 0736-4679

Digital Object Identifier (DOI)

  • 10.1016/j.jemermed.2008.06.028


  • eng

Conference Location

  • United States