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

• Published in: Stroke (1970) Vol. 39; no. 5; pp. 1470 - 1475
• Main Authors: Eggers, Jürgen, König, Inke R., Koch, Björn, Händler, Götz, Seidel, Günter
• Format: Journal Article
• Language: English
• Published: Hagerstown, MD Lippincott Williams & Wilkins 01.05.2008
• Subjects: Acute Disease - therapy; Aged; Biological and medical sciences; Blood. Blood coagulation. Reticuloendothelial system; Brain Ischemia - diagnostic imaging; Brain Ischemia - drug therapy; Brain Ischemia - physiopathology; Female; Fibrinolytic Agents - therapeutic use; Humans; Infarction, Middle Cerebral Artery - diagnostic imaging; Infarction, Middle Cerebral Artery - drug therapy; Infarction, Middle Cerebral Artery - physiopathology; Intracranial Hemorrhages - etiology; Intracranial Hemorrhages - physiopathology; Male; Medical sciences; Middle Aged; Middle Cerebral Artery - diagnostic imaging; Middle Cerebral Artery - drug effects; Middle Cerebral Artery - physiopathology; Neurology; Pharmacology. Drug treatments; Recombinant Proteins - therapeutic use; Tissue Plasminogen Activator - therapeutic use; Treatment Outcome; Ultrasonography, Doppler, Transcranial - methods; Vascular diseases and vascular malformations of the nervous system; Sonography; acute; Stroke; Nervous system diseases; Serine endopeptidases; Enzyme; Middle cerebral artery; Color; Cardiovascular disease; transcranial ultrasound; t-Plasminogen activator; Cerebral disorder; Vascular disease; Peptidases; ischemic; Treatment; Ischemia; Central nervous system disease; thrombolytic therapy; Hydrolases; Ultrasound; Cerebrovascular disease
• ISSN: 0039-2499; 1524-4628; 1524-4628
• DOI: 10.1161/STROKEAHA.107.503870

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 ( P =0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score ≤1 (none from the no-US group) and 8 had a Barthel Index ≥95 (none from the no US group; P =0.106 and P =0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group ( P =0.60). 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.