Impact of Transcranial Doppler Ultrasound on Logistics and Outcomes in Stroke Thrombolysis

Way above my pay grade but you'll have to hope like hell your stroke hospital knows what the protocol for this should look like.
http://stroke.ahajournals.org/content/early/2018/05/25/STROKEAHA.118.021485?fl=4&cn=ZmxleGlibGVfcmVjc18y&refsrc=email

Results From the SITS-ISTR

Michael V. Mazya, Niaz Ahmed, Elsa Azevedo, Antoni Davalos, Laura Dorado, Michal Karlinski, Svetlana Lorenzano, Jiří Neumann, Danilo Toni, Tiago P. Moreira, on behalf of the SITS Investigators

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https://doi.org/10.1161/STROKEAHA.118.021485

Stroke. 2018;STROKEAHA.118.021485

Originally published May 29, 2018

Michael V. Mazya

From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.);Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.);

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Niaz Ahmed

From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.);Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.);

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Elsa Azevedo

Department of Neurology, Hospital São João, University of Porto, Portugal (E.A.);

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Antoni Davalos

Department of Neurosciences, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (A.D., L.D.)

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Laura Dorado

Department of Neurosciences, Stroke Unit, Hospital Universitari Germans Trias i Pujol, Universitat Autònoma de Barcelona, Badalona, Spain (A.D., L.D.)

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Michal Karlinski

Second Department of Neurology, Institute of Psychiatry and Neurology, Warsaw, Poland (M.K.);

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Svetlana Lorenzano

Department of Neurology and Psychiatry, University of Rome–La Sapienza, Italy (S.L., D.T.).

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Jiří Neumann

Department of Neurology and Stroke Center, County Hospital Chomutov, Czech Republic (J.N.);

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Danilo Toni

Department of Neurology and Psychiatry, University of Rome–La Sapienza, Italy (S.L., D.T.).

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Tiago P. Moreira

From the Department of Neurology, Karolinska University Hospital, Stockholm, Sweden (M.V.M., N.A., T.P.M.);Department of Clinical Neuroscience, Karolinska Institutet, Stockholm, Sweden (M.V.M., N.A., T.P.M.);

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Abstract

Background and Purpose—Diagnostic transcranial Doppler ultrasound (TCD) is commonly used in patients with acute stroke before or during treatment with intravenous thrombolysis (IVT). We aimed to assess how much TCD delays IVT initiation and whether TCD influences outcomes.

Methods—We analyzed data from the SITS-ISTR (Safe Implementation of Thrombolysis in Stroke–International Stroke Thrombolysis Register) collected from December 2002 to December 2011. Outcomes were door-to-needle time, symptomatic intracerebral hemorrhage, functional outcome per the modified Rankin Scale, and mortality at 3 months.

Results—In hospitals performing any TCD pre-IVT, 1701 of 11 265 patients (15%) had TCD before IVT initiation. Door-to-needle time was higher in patients with pre-IVT TCD (74 versus 60 minutes; P<0.001). At hospitals performing any TCD during IVT infusion, of 9044 patients with IVT, 747 were examined with TCD during IVT. No treatment delay was seen with TCD during IVT. After multivariate adjustment, TCD during IVT was independently associated with modestly increased excellent functional outcome (modified Rankin Scale, 0–1; adjusted odds ratio, 1.28; 95% confidence interval, 1.06–1.55; P=0.012) and lower mortality (adjusted odds ratio, 0.73; 95% confidence interval, 0.55–0.95; P=0.022).

Conclusions—We recommend that TCD, if performed, should be done during IVT infusion, to avoid treatment delay. The association of hyperacute TCD with beneficial outcomes suggests potential impact on patient management, which warrants further study.

• infarction, cerebral
• reperfusion
• stroke
• thrombolysis, therapeutic
• tissue-type plasminogen activator
• ultrasonography, Doppler, transcranial

• Received January 24, 2018.
• Revision received April 23, 2018.
• Accepted May 4, 2018.

• © 2018 American Heart Association, Inc.

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