A case of recanalized cardioembolic stroke: Possible effect of transcranial color-coded real-time sonography on thrombolytic therapy

Thrombolytic therapy appears to be one of the most valuable treatments for acute ischemic stroke. The major objective of thrombolysis in acute ischemic stroke is to recanalize occluded arteries to reestablish brain function by saving tissue from ischemic risk. Rapid lysis of intracranial clots has been strongly associated with early neurologic improvement, reduction of infarct size, and favorable outcome. It has been reported in vitro and in animal models that the combination of the administration of tissue plasminogen activator (t-PA) and the application of ultrasound was effective for thrombolysis. Moreover, Alexandrov et al have recently shown that the reperfusion rate of occluded arteries by t-PA is improved by the combined therapy with the application of ultrasound. Here we report a patient with cardioembolic stroke whose occluded middle cerebral artery (MCA) was recanalized during an examination with transcranial color-coded real-time sonography (TCCS) after thrombolytic therapy by urokinase. The combined therapy of ultrasound with urokinase may also be effective in the treatment of acute ischemic stroke.