Efficacy evaluation of thrombolysis in brain ischemia by transcranial Doppler flow grading in patients with acute middle cerebral artery occlusion

Objective To investigate the clinical efficacy of thrombolysis in brain ischemia (TIBI) transcranial Doppler (TCD) flow grading in patients with acute middle cerebral artery (MCA) occlusion. Methods Thirty-six patients with acute MCA occlusion diagnosed by TCD were selected for thrombolysis (≤ 6 h) by intravenous injection of recombinant tissue-type plasminogen activator (rt-PA) or urokinase. The changes of blood flow in the patients were observed before and after the thrombolytic therapy. The correlation of TIBI flow grading between the NIHSS scores before the thrombolysis and the modified Rankin scale scores 3 months after the thrombolysis were evaluated. Results Of the 36 patients, the TIBI flow grading 0-1 in 21 patients (58.3%) and 2-3 grading in 15 patients(41.7%) before the thrombolysis. The second day after the thrombolysis, the TIBI flow grading 0-1, 2-3, and 4-5 were 7 (19.4%), 14 (38.9%), and 15 patients(41.7%), respectively. The TIBI flow grading before the thrombolysis were negatively correlated with the National Institutes of Health Stroke Scale (NIHSS) scores (r=-0.829,P=0.000); and after the thrombolysis were negatively correlated with the modified Rankin scale scores(r=-0.57,P=0.001). Conclusion TIBI is correlated with the neurological deficit scores of acute MCA occlusion, which may reflect the efficacy of thrombolysis, and help to predict the prognosis.