Study of transcranial Doppler flow grades of thrombolysis in brain ischemia in patients with acute middle cerebral artery occlusion after alteplase treatment

Abstract

Objective To investigate the relationship between changes of blood flow of acute middle cerebral artery (MCA) occlusion or stenosis and degree of neural function defect and prognosis before and after intravenous thrombolytic therapy with alteplase. Methods Fifty-three patients diagnosed as acute MCA stenosis or occlusion and given alteplase intravenous thrombolysis therapy were enrolled. Thrombolysis in brain ischemia (TIBI) flow grades of MCA before and 24 h after the thrombolysis were assessed. The correlation between TIBI flow grades and National Institute of Health Stroke Scale (NIHSS) scores and modified Rankin Scale (mRS) scores 90 d after the thrombolysis was evaluated. Results There were significant differences in the NIHSS scores before intravenous thrombolytic therapy among different TIBI flow grades (H = 36.514, P = 0.000). The TIBI flow grade was negatively correlated with the NIHSS scores before thrombolysis (rs = -0.737, P = 0.000), indicating that lower TIBI grade of MCA presented the nerve function defect worse. Compared with before thrombolytic therapy, there were 25 cases (47.17% ) achieved to grade 4-5 of TIBI flow grade of MCA 24 h after thrombolytic therapy, suggesting the recanalization of MCA (Z = 5.262, P = 0.000). In comparision with pre-thrombolytic therapy, neural function of 38 cases (71.70% ) recovered well 24 h after treatment, and the difference of NIHSS scores was statistically significant while that of 15 cases (28.30%) did not obtain favorable recovery of neural function(Z = -6.353, P = 0.000). There were significant differences in mRS scores 90 d after the thrombolysis among different TIBI flow grades 24 h after the thrombolysis (χ2 = 31.973, P = 0.000), and they were negatively correlated with each other (rs = -0.683, P = 0.001). According to mRS scores, 36 cases (67.92%) obtained favorable outcome but 17 cases (32.08%) was unfavorable 90 d after the therapy. Conclusion TIBI flow grade is correlated with neurological deficit and its recovery in acute MCA occlusion or stenosis, which may reflect the efficacy of thrombolytic therapy and help to predict the prognosis.