Original Paper

The Eligible Study: Ultrasound Assessment in Acute Ischemic Stroke within 3 Hours
Giovanni Malferrari^a, Chiara Bertolino^c, Federica Casoni^b, Andrea Zini^b, Vittoria M. Sarra^a, Sandro Sanguigni^d, Mauro Pratesi^e, Piergiorgio Lochner^f, Lorenzo Coppo^g, Giulia Brusa^h, Donata Guidettiⁱ, Silvio Cavuto^j, Norina Marcello^a, for the Eligible Group and SINV Group

^aNeurology Department, Arcispedale S. Maria Nuova, Reggio Emilia,
^bDepartment of Neuroscience, University of Modena and Reggio Emilia, Nuovo Ospedale Civile 'S. Agostino-Estense', Modena,
^cNeurology Division, Ospedale privato 'San Giacomo', Ponte dell'Olio, Piacenza,
^dNeurology Department, 'Madonna del Soccorso' Hospital, San Benedetto del Tronto,
^eDepartment of Medicine and Radiology, S. Maria Annunziata Hospital, Bagno a Ripoli, Firenze,
^fNeurology Department, Ospedale 'F. Tappeiner', Merano,
^gNeurology Department, Azienda Ospedaliera Maggiore della Carità, University of Piemonte Orientale 'A. Avogadro', Novara,
^hNeurology Department, University Hospital S. Martino, Genova,
ⁱNeurology Division, Ospedale 'Guglielmo da Saliceto', Piacenza,
^jLombardy Cancer Registry and Environmental Epidemiology Department, National Cancer Institute, Milan, Italy

Address of Corresponding Author

Cerebrovasc Dis 2007;24:469-476 (DOI: 10.1159/000108922)

  Key Words

• Acute stroke
• Ultrasound
• Doppler
• Transcranial color-coded duplex sonography

  Abstract

Background: Aims of the study: to identify with echo color Doppler ultrasound of the supra-aortic vessels and transcranial color-coded duplex sonography (TCCD) various patterns of vessel occlusion within 3 h from stroke onset, to compare each group defined at the admission with clinical findings and outcome, and to study the recanalization process, independent of therapy. Methods: We enrolled 89 consecutive patients (mean age 68.9 years). Ultrasound evaluation was done within 3 h from stroke onset, and was repeated at 3-6 and 24-36 h, at day 5, and at 3 months. At admission, patients were divided into the following groups: internal carotid artery occlusions and stenoses (<50%, 50-69%, 70%, near occlusion), middle cerebral artery stenoses and occlusions, tandem occlusions and T occlusions. Vascular recanalization in each group was evaluated. Subgroups were compared for NIH Stroke Scale (NIHSS) and the outcome measures mortality, Barthel index (BI) and modified Rankin scale (mRS). Favorable outcome was defined as mRS 2 and BI 90. Results: Each subgroup differed significantly for baseline NIHSS (p < 0.0001), 3-month mortality (p = 0.0235), BI at day 5 (p = 0.0458) and mRS at 3 months (p = 0.0028), even after adjustment for treatment. T and tandem occlusions were the subgroups with the highest NIHSS scores and the poorest outcomes, and the same subgroups had the worst recanalization rates. Conclusions: TCCD in the acute setting of stroke patients allows identification of the presence and site of clots, prediction of outcome and study of the dynamic process of vessel recanalization, in both the acute phase and follow-up.

Copyright © 2007 S. Karger AG, Basel

  Author Contacts

Dr. Andrea Zini
Department of Neuroscience, University of Modena and Reggio Emilia
Nuovo Ospedale Civile 'S.Agostino-Estense', via Giardini 1355 Baggiovara
IT-41100 Modena (Italy)
Tel. +39 522 296 494, Fax +39 522 296 935, E-Mail malferrari.giovanni@asmn.re.it

  Article Information

Received: July 28, 2006
Accepted: June 4, 2007
Published online: September 24, 2007
Number of Print Pages : 8
Number of Figures : 3, Number of Tables : 2, Number of References : 24