DIAS I: Duplex-sonographic assessment of the cerebrovascular status in acute stroke - A useful tool for future stroke trials

Background and Purpose-A number of controlled trials have evaluated the ben efit of intravenous thrombolysis in acute stroke with inconsistent results. None of these studies assessed the initial vascular status or provided inf ormation regarding the recanalization rate after therapy. Further trials ne ed to clarify whether certain subgroups might possibly benefit more than ot hers from intravenous thrombolysis. Therefore, a fast and valid method for assessment of cerebrovascular status is needed. Ln this multicenter study, we evaluated the potentials and limitations of color-coded duplex sonograph y (TCCS) for cerebrovascular status assessment in acute stroke patients bef ore and after therapy. furthermore, we compared the recanalization rate for patients referred to thrombolytic and conservative medical therapy. Methods-Fifty-eight patients suffering from hemispheric stroke were enrolle d consecutively in 8 centers. Duplex sonography was performed on admission, 2 hours after start of therapy, and 24 hours after onset of symptoms. Ther apy was started within 6 hours. Results-Intravenous thrombolysis was performed in 18 patients, conservative medical therapy in 39 patients, and early thromboendarterectomy in 1 patie nt. The middle cerebral artery (MCA) mainstem was patent in 29 patients (53 .7%), occluded in 25 (46.3%), and was not assessable in 4 patients. Recanal ization of the occluded MCA after 2 and 24 hours was diagnosed in 50% and 7 8% of the patients treated with rtPA and in 0% and 8% in the conservatively treated patients. Conclusions-Intravenous thrombolysis is highly effective in restoring blood flow after MCA occlusion. TCCS is suitable for assessment of the cerebrova scular status in acute stroke and therefore might define therapeutically re levant subgroups of patients in future stroke trials on the basis of their vascular pathology.