The Safety and Efficacy of Continuous Transcranial Duplex Doppler Monitoring of Middle Cerebral Artery Occlusion in Acute Stroke Patients: Comparison of TCDD and Thrombolysis in MCA Recanalization

BACKGROUND AND PURPOSE Assess the safety and efficacy of the continuous transcranial duplex Doppler (TCDD) monitoring of middle cerebral artery (MCA) (M1-2) occlusion in acute ischemic stroke (IS) patients and compare TCDD to intra-arterial thrombolysis (IAT) and intravenous thrombolysis (IVT). METHODS Forty consecutive acute IS patients were analyzed. Standard IVT was performed within 3 hours since stroke onset in 20 patients; between 3 and 6 hours continual 60 minute TCDD monitoring of occluded MCA using 2-MHz probe was performed in 10 patients and IAT in 10 patients. Neurological deficit was evaluated using the National Institutes of Health Stroke Scale and clinical outcome using modified Rankin Scale. The incidence of symptomatic intracerebral hemorrhage (sICH), clinical outcomes, and recanalization rates were compared among TCDD, IVT, and IAT. Analysis of variance, Kruskal-Wallis, and chi(2) tests were used for statistical evaluation. RESULTS Incidence of sICH was 0% in TCDD group, 5% in IVT, and 20% in IAT (P = .198). Good 90-day clinical outcome (mRS 0-2) was achieved in 70% of TCDD patients (P = .570); recanalization after TCDD was found in 60% of patients (IVT 45%, IAT 70%) (P = .185). CONCLUSION Continual TCDD monitoring might be safe and potentially beneficial in treatment of MCA occlusion.