Ischemic Middle Cerebral Artery Stroke Missing the Tissue Plasminogen Activator Time Window: Transcranial Doppler Evaluation

We investigated the interconnection between natural history of middle cerebral artery (MCA) recanalization by transcranial Doppler (TCD) and stroke severity in patients not treated by fibrinolysis. A total of 54 patients with an acute MCA stroke were examined within the first 24 hours and again within 120 hours after stroke onset. The first TCD examination detected 16 patients (29.6%) with complete occlusion, 27 patients (50%) with partial occlusion, and 11 patients (20.4%) with patent MCA. There were no significant differences among groups according to mean National Institutes of Health Stroke Scale (NIHSS) and modified Rankin scale values. The second examination revealed 7 patients (13.2%) with complete occlusion, 31 patients (58.5%) with partial occlusion, and 15 patients (28.3%) with patent MCA. The mean NIHSS score in patients with total occlusion was significantly higher than in patients without occlusion or with partial occlusion. There was no significant difference in mean NIHSS value between patients with and without improvement on the second TCD examination. We conclude that MCA occlusion by TCD is associated with more severe stroke than that of patients without occlusion or with only a partial occlusion. A later MCA recanalization is not accompanied by significant improvement of neurologic or functional status.