The Application Of TCD Microembolic Signal Monitoring In AIS Patients During Intravenous Thrombolytic Therapy

Objective: To observe the number?occurence rate of Microembolic Signal in Acute Ischemic Stroke patients during the process of rt-PA Administration with Transcranial Doppler.To study relationship between MES occurence rate and prognosis?cerebrovascular-related risk factors?carotid plaques.Method: To monitor the microembolic signals in AIS patients with transcranial doppler for 1 hour during the process of rt-PA administration.Devide the patients into MES positive group and MES negative group according to the occurrence of MES.Collect the general files and risk factors of stroke,including age,gender,BMI,onset time of stroke,history of hypertention,carotid artery atherosclerosis,diabetes,smoking,ESSEN? NIHSS Score(at Admission?1hour after rt-PA administration?7days after administration).Collect the patients' level of blood lipid,glucose,fibrinogen.Hemorrhagic transformed patient under CT scanning in 24 hours after rt-PA administration were excluded.Record the sonographic characteristics and the grades of the carotid plaques with the Doppler ultrasound,comfirm the infarct area with MRI in 3 days.Finally,to analyse the correlation between the occurrence rate of MES and the prognosis?risk factors of cerebrovascular disease?carotid plaques.Results:(1)33 qualified AIS patients were enrolled in the study,aged 67.18± 9.01 y,including 23 males and 10 females(69.7% vs 30.3%),6 males and 2 females(75% vs 25%)in MES positive group compared with 17 males and 8 females in MES negative group,differences were not statistically significant.(2)Patients of overweight?with history of hypertention/diabetes/artery atherosclerosis/smoking respectively had the proportion of 50%?75%?37.5%?50%?37.5% in MES positive goup,52%?68%?48%?52%?60% in negative group,no significance in statistics.(3)Level of blood LDL in MES positive group is higher than negative one,but no significance in statistics.levels of HDL?TC?TG?glucose?fibrinogen between the two group has no difference in statistics.(4)According to the risk level of carotid plaques,patients' comorbidity of low/moderate/high/extremely high risk plaque respectively accounts for 12.5%?12.5%?25%?37.5%?12.5%in postive group,12%?16%?40%?24%?8% in negative group.differences between the two group were not statistically significant.(5)MES negative group get recovery in NHISS to a larger extent compared with MES positve group after rt-PA administration(1.68±2.14 vs.0.5±2,P=0.178),also in 7 days(2.24±2.54 vs.0.375±1.69,P=0.06),but not statistically significant.Conclusion:The occurrence of MES were found mostly in the moderate-high grades plaques.Existence of MES may have negative effect on the short-term prognosis of the patients.