Q: You have been called to evaluate a 44 year old male in ER for acute CVA. Patient is still within time limit of thrombolytic therapy and t-PA is ordered. Which one added therapy may help as an adjuvant treatment?

Answer: Cranial doppler

By delivering mechanical pressure waves to the thrombus, ultrasound can theoretically expose more of the thrombus’s surface to the circulating fibrinolytic agent. It is not a standard of treatment but may help in young patients. Neurology team should be consulted.

Reference:

Alexandrov AV, Molina CA, Grotta JC, Garami Z, Ford SR, Alvarez-Sabin J, et al. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med. Nov 18 2004;351(21):2170-8.

Tsivgoulis G, Eggers J, Ribo M, Perren F, Saqqur M, Rubiera M, et al. Safety and efficacy of ultrasound-enhanced thrombolysis: a comprehensive review and meta-analysis of randomized and nonrandomized studies. Stroke. Feb 2010;41(2):280-7.