Title | Use of emergency department transcranial Doppler assessment of reperfusion after intravenous tPA for ischemic stroke. |
Publication Type | Journal Article |
Year of Publication | 2012 |
Authors | Phillips S, Stanley L, Nicoletto H, Burkman M, Laskowitz DT, Cairns CB |
Journal | J Emerg Med |
Volume | 42 |
Issue | 1 |
Pagination | 40-3 |
Date Published | 2012 Jan |
ISSN | 0736-4679 |
Keywords | Aged, Brain Ischemia, Cerebrovascular Circulation, Emergency Service, Hospital, Fibrinolytic Agents, Humans, Infarction, Middle Cerebral Artery, Infusions, Intra-Arterial, Male, Reperfusion, Tissue Plasminogen Activator, Treatment Failure, Ultrasonography, Doppler, Transcranial |
Abstract | 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. |
DOI | 10.1016/j.jemermed.2008.06.028 |
Alternate Journal | J Emerg Med |
PubMed ID | 19111426 |
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