Effects of low-dose rt-PA thrombolysis with transcranial color-coded duplex sonography monitoring in anterior circulation large vessel occlusion acute ischemic stroke

Purpose To evaluate the effects of low-dose intravenous rt-PA combined with continuous TCCD monitoring on recanalization and radiologic outcomes in patients with anterior circulation AIS-LVO, using CTA and MRI-based assessments. Methods This retrospective cohort study included 150 AIS-LVO patients treated with low-dose rt-PA between October 2022 and March 2025. Patients were divided into TCCD group (n = 71) and low-dose rt-PA alone group (n = 79). Recanalization was assessed by Thrombolysis in Brain Ischemia (TIBI) grade at 2 h and by modified Thrombolysis in Cerebral Infarction (mTICI) on follow-up CTA or MRA at 24–48 h. Neurological outcomes were measured using the NIHSS at baseline, 2 h, 24 h, and discharge. Functional outcome at 90 days was assessed by the mRS. Radiologic parameters, including clot burden score, collateral status, and hemorrhagic transformation, were also evaluated on baseline and follow-up CT/CTA images. Results The TCCD group had significantly higher rates of any recanalization at 2 h (P = 0.007) and sustained recanalization at 24–48 h (P = 0.041). NIHSS scores were lower in the TCCD group at 2 h, 24 h, and discharge (P < 0.05). Early neurological improvement was more frequent in the TCCD group (P = 0.009). Favorable functional outcome at 90 days was significantly higher in the TCCD group compared with the low-dose rt-PA alone group (63.38% vs. 45.57%; adjusted OR 2.12, 95% CI 1.08–4.16; P = 0.029). Conclusion Low-dose intravenous rt-PA combined with continuous TCCD monitoring is associated with higher recanalization rates, better neurological recovery, and improved functional outcome in patients with anterior circulation LVO-AIS, without increasing hemorrhagic complications.