Sonothrombolysis With Transcranial Color-Coded Sonography and Recombinant Tissue-Type Plasminogen Activator in Acute Middle Cerebral Artery Main Stem Occlusion

Abstract

Background and Purpose-Sonothrombolysis is a new treatment approach in acute ischemic stroke. The results of a monocenter, randomized clinical study are presented. Methods-Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a 1.8-MHz Doppler ultrasound (US) probe or a control group. All underwent standard thrombolysis with intravenous recombinant tissue-type plasminogen activator. Results-Thirty-seven subjects were included; 19 subjects were treated in the target (US) group and 18 in the control (no-US) group, all with no residual flow in the middle cerebral artery main stem occlusion (Thrombolysis in Brain Ischemia recanalization grade 0). Compared with the no-US group, the US group showed greater improvement in National Institutes of Health Stroke Scale values at days 1 and 4 and a higher median Thrombolysis in Brain Ischemia grade 1 hour after recombinant tissue-type plasminogen activator initiation. Recanalization (complete or partial) after 1 hour occurred in 57.9% of the US group and 22.2% of the no-US group (Pϭ0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score Յ1 (none from the no-US group) and 8 had a Barthel Index Ն95 (none from the no US group; Pϭ0.106 and Pϭ0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group (Pϭ0.60). Conclusions-This small randomized study indicates a beneficial impact of transcranial ultrasound on recanalization and short-term outcome in subjects with middle cerebral artery main stem occlusion and recombinant tissue-type plasminogen activator treatment.

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

“…In the CLOTBUST trial (using Doppler), no difference in the rate of symptomatic hemorrhage was detected between ultrasound treated and control patients (Alexandrov et al, 2004). Eggers et al (2008) (TCCS) found a trend toward an increased rate of symptomatic bleeding. Molina et al (2006) (Doppler), who added the contrast agent Levovist to the treatment protocol, and Perren et al (2008) (TCCS with SonoVue) did not detect differences in the incidence of intracranial hemorrhage.…”

“…It provides functional and prognostic information valuable for individual patient management (Allendoerfer et al, 2006;Nedelmann et al, 2009;Perren et al, 2006;Wunderlich et al, 2007). Next to diagnostic applications, randomized clinical studies suggest therapeutic efficacy of ultrasound on recanalization of acute cerebral artery occlusion in terms of an acceleration of fibrinolysis with recombinant tissue-type plasminogen activator (rt-PA) (Alexandrov et al, 2004;Eggers et al, 2008). Echo contrast agents may further improve treatment efficacy (Molina et al, 2006;Perren et al, 2008).…”

The use of transcranial focused ultrasound in CNS diseases

“…J. Eggers и соавт. [79] продемонстриро-вали, что добавление к тканевому активатору плазминоге-на ультразвукового воздействия (модификация транскра-ниальной допплерографии) в течение часа увеличивает частоту полной и частичной реканализации с 22,2 до 57,9% (p=0,045).…”

A historical perspective towards a non-invasive treatment for patients with atherosclerosis

“…Small clinical trials have shown promising results concerning the potential application of ultrasound-enhanced thrombolysis in acute cerebral ischaemia. 28,29 Moreover, the combination of intravenous gaseous microspheres (microbubbles) with ultrasound has been shown to be a potential alternative to recanalise intravascular thrombi. Recently, the first clinical trial has started regarding ultrasound enhanced thrombolysis using microbubbles in patients with acute ST-elevation myocardial infarction.…”