Evaluating the intracranial arteries emergently as a stroke is in progress uniquely positions the transcranial Doppler (TCD) as a tool to not only help diagnose the cause of the stroke but to serially monitor the cerebral arteries before, during, and after emergent pharmaceutical and/or endovascular interventions. Five Doppler waveforms are presented each representing a potential hemodynamic cause of the patient's symptoms. These waveforms can be easily obtained in the CODE STROKE room by a Registered Vascular Technologist without interfering with the emergent nursing protocols.
Get full access to this article
View all access options for this article.
References
1.
Guidelines for the early management of adults with ischemic stroke: Guidelines from the American Heart Association/American Stroke Association. Stroke2007; 38(6): 1655–1711.
2.
FiorellaD., DerdeynC.P., LynnM.J.Detailed analysis of periprocedural strokes undergoing intracranial stenting and aggresive medical management for preventing recurrent stroke in intracranial stenosis. (SAMMPRIS results). Stroke2012; 43: 2682–2688.
3.
WilliamJ.P., JoséB., ChristopherS.C.2015 AHA/ASA Focused Update of the 2013 Guidelines for the Early Management of Patients with Acute Ischemic Stroke Regarding Endovascular Treatment. Stroke. 2015 published on-line June 29, 2015, 10.1161/STR 0000000000074.
4.
DemchukA.M., ChristouI., WeinT.H.Thrombolysis in brain ischemia (TIBI). TCD flow grades predict clinical severity, early recovery, and mortality in intravenous tPA treated patients. Stroke2003; 31: 140–146.
5.
AlexandrovA.V., MolinaC.A., GrottaJ.C.Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med2004; 351: 2170–2178.
6.
MolinaC.A., BarretoA.D., TsivogoulisG.Transcranial ultrasound in clinical sonothrombolysis (TUSCON) trial. Ann Neurol2009; 66: 28–38.
7.
TsivgoulisG., SaqqurM., MolinaC.A.Safety and efficacy of ultrasound-enhanced thrombolysis. Stroke2010; 41: 280–287.
8.
AlexandrovAndrei, ed. Cerebrovascular Ultrasound in Stroke Prevention and Treatment, 2nd ed.Oxford, United Kingdom: Wiley-Blackwell Publishers; 2011: 13–25.
9.
AlexandrovAndrei ed. Cerebrovascular Ultrasound in Stroke Prevention and Treatment, 2nd ed.Oxford, United Kingdom: Wiley-Blackwell Publishers; 2011: 241–242.
10.
AaslidRune, ed. Transcranial Doppler Sonography.New York, NY: Verlag-Springer Publishers; 1986.
11.
BurginW.S., MalkoffM., FelbergR.A.Real-time validation of transcranial Doppler criteria in assessing recanalization after thrombolysis for middle cerebral artery stroke. Stroke2000; 31: 1128–1132.
12.
BarnettH.J., PeerlessS.J., KaufmannJ.C.“Stump” on internal carotid artery-a source for further cerebral embolic ischemia. Stroke1978; 9: 448–456.
13.
KneelandP., FangM.Current issues in patient adherence and persistence: Focus on anticoagulants for the treatment and prevention of thromboembolism. Patient Prefer Adherence2010; 4: 51–60.
14.
AlexandrovA.V., MolinaC.A., GrottaJ.C.Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med2004; 351: 2170–2178.
15.
AlexandrovA.V., MolinaC.A., GrottaJ.C.Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med2004; 351: 2170–2178.