Transcranial Doppler ultrasound evaluation of vascular recanalization following tissue plasminogen activator intravenous thrombolysis in acute middle cerebral artery occlusion: A case report and literature review

Acute cerebral infarction, or stroke, is one of the leading causes of death and disability among adults worldwide, and the key to its treatment is achieving early recanalization of occluded blood vessels, methods for which include intravenous thrombolysis and mechanical thrombectomy. This article reports a case of a 43-year-old female who suddenly suffered acute cerebral infarction and was treated with tissue plasminogen activator intravenous thrombolysis. During the thrombolysis process, transcranial Doppler ultrasound was used to evaluate acute occlusion of the left middle cerebral artery, which was confirmed via an emergency head magnetic resonance angiography and digital subtraction angiography. Before mechanical thrombectomy, repeat angiography showed that the occluded left middle cerebral artery had regained blood flow, and after postoperative follow-up transcranial Doppler ultrasound, the blood flow of the left middle cerebral artery and anterior cerebral artery was found to have fully recovered. The patient's symptoms were completely relieved, and they were discharged after 7 days of treatment, with follow-up at 2 weeks and 3 months showing no abnormal symptoms or intracranial blood flow. This case not only provides evidence that tissue plasminogen activator intravenous thrombolysis can salvage the ischemic penumbra, dissolve thrombi, and encourage reperfusion in occluded intracranial large arteries, but it also emphasizes the critical role of transcranial Doppler ultrasound in the rapid assessment of acute large vessel occlusions. As such, our report highlights the importance of transcranial Doppler ultrasound in clinical interventions to optimize outcomes in acute stroke management.