Transcranial Ultrasonography

Currently, no standard, rapid method is available to functionally image the cerebral vasculature for recanalization after thrombolysis administration in suspected large vessel ischemic strokes. Taking the patient outside of the emergency room or ICU setting to undergo a CT scan, MRI, or angiography is potentially dangerous. With the advancement of ultrasound technology, the use of transcranial-Doppler ultrasonography (TCD) is being researched. The advantage of TCD is that it is a rapid, bedside assessment that can continuously monitor the offending vessel and provide valuable data about its morphology. If recanalization and clinical improvement are not seen with standard therapy, other available modalities (e.g., IA therapy) can potentially be considered more rapidly. TCD has been shown to be sensitive and specific in determining arterial occlusion in acute stroke (36). Continuous TCD monitoring has also shown clot lysis during and immediately following rtPA administration (37). Moreover, the Combined Lysis of Thrombus in Brain ischemia using transcranial Ultrasound and Systemic TPA trial has shown promising results, suggesting that continuous 2-MHz TCD of a cerebral vessel occlusion augments rtPA-induced arterial recanalization (38). The ongoing Microbubbles and Ultrasound in Stroke trial is using focused, 2-MHz, low-intensity ultrasound combined with IV micro-bubbles in patients with acute MCA stem occlusion, who have also received IV rtPA.

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