The Efficacy of Sonothrombotripsy and Sonothrombolysis on Accelerated Recanalization of the Middle Cerebral Artery


Authors: D. Školoudík 1,2;  M. Bar 2;  O. Škoda 3;  D. Václavík 4;  P. Hradílek 1;  K. Langová 5;  R. Herzig 2;  P. Kaňovský 2
Authors‘ workplace: Neurologická klinika FNsP Ostrava-Poruba, Ostrava 1;  Iktové centrum, Neurologická klinika LF UP a FN, Olomouc 2;  Neurologické oddělení Nemocnice Pelhřimov 3;  Neurologické oddělení Vítkovické nemocnice, Ostrava 4;  Oddělení biometrie, Ústav lékařské biofyziky LF UP, Olomouc 5
Published in: Cesk Slov Neurol N 2007; 70/103(3): 248-252
Category: Original Paper

Výsledky studie byly prezentovány formou přednášky na 38th Danube Symposium, Brno, 7. 4. 2006, 32. Česko-slovenském cerebrovaskulárním sympoziu ve Zlíně 17. 6. 2006 a formou posteru na 11th Meeting of ESNCH SRN 15. 5. 2006 v Düsseldorfu, SRN.

Overview

Introduction:
Recent studies have shown probable effects of transcranial ultrasound monitoring on accelerated recanalization of intracranial arteries, both in patients treated with systemic thrombolysis (sonothrombolysis, S-lysis) and in combination with antiaggregation therapy (sonothrombotripsy, S-tripsy). The aim was to compare the efficacy of S-lysis and S-tripsy on the recanalization of the middle cerebral artery (MCA) occlusion inpatients with acute cerebral ischemia.

Patients and Methods:
The study involved patients with acute occlusion of MCA (M1 or M2). S-lysis was applied by 3 hours in 24 patients (5 men, age 58.7 ± 12.9 years, median NIHSS 17 ± 5.1, 18 occlusions of M1) and S-tripsy was used by 12 hours after appearing the signs in 62 patients (41 men, aged 62.9 ± 12.5 years, median NIHSS 14.0 ± 5.7, 44 occlusions of M1). Diagnostic transcranial duplex sonography (TCCS) was carried out at the admission, 1 hour after starting the therapy, 6 and 24 hours after appearing the signs with evaluating the artery occlusion and its successive partial or complete recanalization.

Results:
The following was found out in groups with S-lysis versus S-tripsy: complete/partial recanalization 1 hour after the therapy initiation in 42%/25% vs 26%/56% (p > 0.05), complete recanalization 6/24 hours after appearing the signs in 61%/71% vs 52%/65% (p > 0.05), Symptomatic intracerebral bleeding in 1 (4%) vs 1 (2%) patient, and independency after 90 days (mRS 0-2) in 50% vs 44% patients (p > 0.05). The recanalization velocity was independent on age, sex, time elapsed by the therapy initiation or the application of echocontrast.

Conclusion:
The patients treated with the combination of systemic thrombolysis and transcranial ultrasound monitoring reached nonsignificantly higher number of complete recanalizations of the cerebral artery within the first 24 hours if compared with subjects treated only with sonothrombotripsy.

Key words:
transcranial ultrasound – thrombolysis – cerebrovascular accident – recanalization – a. cerebri media


Sources

1. Molina CA, Saver JL. Extending Reperfusion Therapy for Acute Ischemic Stroke. Emerging Pharmacological, Mechanical, and Imaging Strategie. Stroke 2005; 36: 2311-20.

2. The National Institute of Neurological Disorders and Stroke rt-PA Stroke Study Group. Tissue Plasminogen Activator for Acute Ischemic Stroke. N Engl J Med 1995; 333: 1581-7.

3. Mikulík R. Historie, současnost a budoucnost trombolytické terapie mozkového infarktu Česk Slov Neurol N 2002; 98: 223–31.

4. Rha J-H, Saver JL. Recanalization as a surrogate outcome measure in thrombolytic clinical trials: a meta-analysis. Stroke 2003; 34: 317 [abstract]..

5. Del Zoppo GJ, Higashida RT, Furlan AJ, Pessin MS, Rowley HA, Gent M. PROACT: a phase II randomized trial of recombinant pro-urokinase by direct arterial delivery in acute middle cerebral artery stroke. Stroke 1998; 29: 4–11.

6. Ng PP, Higashida RT, Cullen SP, Malek R, Dowd CF, Halbach VV. Intraarterial Thrombolysis Trials in Acute Ischemic Stroke. J Vasc Int Radiol. 2004; 15 (Suppl. 1): 77-85.

7. Mahon BR, Nesbit GM, Barnwell SL, Clark W, Marotta TR, Weill A et al. North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 2003; 24: 534 –8.

8. Nesbit GM, Luh G, Tien R, Barnwell SL. New and future endovascular treatment strategies for acute ischemic stroke. J Vasc Interv Radiol 2004; 15 (Suppl. 1): 103–10.

9. Qureshi AI, Siddiqui AM, Suri MF, Kim SH, Ali Z, Yahia AM et al. Aggressive mechanical clot disruption and low-dose intra-arterial thirdgeneration thrombolytic agent for ischemic stroke: a prospective study. Neurosurgery 2002; 51: 1319 –27.

10. Ringer AJ, Qureshi AI, Fessler RD, Guterman LR, Hopkins LN. Angioplasty of intracranial occlusion resistant to thrombolysis in acute ischemic stroke. Neurosurgery 2001; 48: 1282–8.

11. Starkman S, MERCI Investigators. Results of the combined MERCI I-II (Mechanical Embolus Removal in Cerebral Ischemia) Trials. Stroke 2004; 35: 240.

12. Daffertshofer M, Fatar M. Therapeutic ultrasound in ischemic stroke treatment: experimental evidence. Eur J Ultrasound 2002; 16: 121-30.

13. Francis CW, Onundarson PT, Carstensen EL, Blinc A, Meltzer RS, Schwarz K et al. Enhancement of fibrinolysis in vitro by ultrasound. J Clin Invest 1992; 90: 2063-68.

14. Ishibashi T, Akiyama M, Onoue H, Abe T, Furuhata H. Can transcranial ultrasonication increase recanalization flow with tissue plasminogen activator. Stroke 2002; 33: 917-25.

15. Francis CW, Behrens S. Ultrasonic thrombolysis. In: Hennerici M, Meairs S. Cerebrovascular ultrasound. Cambridge University Press 2001: 404-15.

16. Alexandrov AV, Demchuk AM, Felberg RA, Christou I, Barber PA, Burgin WS et al. High rate of complete recanalisation and dramatic clinical recovery during tPA infusion when continuously monitored with 2-MHz transcranial Doppler monitoring. Stroke 2000; 31: 610-4.

17. Alexandrov AV, Demchuk AM, Burgin WS, Robinson DJ, Grotta JC. Ultrasound-enhanced thrombolysis for acute ischemic stroke: phase I. Findings of the CLOTBUST trial. J Neuroimaging 2004; 14: 113–7.

18. Toni D, Lorenzano S, Puca E, Prencipe M. The SITS-MOST registry. Neurol Sci 2006; 27 (Suppl 3): 260-2.

19. The European Stroke Initiative Executive Committee and the EUSI Writing Committee. European Stroke Initiative recommendations for stroke management - update 2003. Cerebrovasc Dis 2003; 16: 311-37.

20. Demchuk, AM, Burgin, SW, Christou, I., Felberg RA, Barber PA, Hill MD et al. Thrombolysis in brain ischemia (TIBI) transcranial Doppler flow grades predict clinical severity, early recovery, and mortality in patients treated with intravenous tissue plasminogen activator. Stroke 2001; 32: 89–93.

21. Školoudík D, Bar M, Škoda O, Václavík D, Hradílek P, Šimíčková K. Bezpečnost a účinnost trombotripse – akcelerace trombolýzy pomocí ultrazvuku. Česk Slov Neurol N 2004: 99; 157–61.

22. Školoudík D, Bar M, Škoda O, Václavík D. Thrombotripsy study – case control study. Cerebrovasc Dis 2005: Suppl. 1: 14.

23. Eggers J, Koch B, Meyer K, Konig I, Seidel G. Effect of ultrasound on thrombolysis of middle cerebral artery occlusion. Ann Neurol 2003; 53: 797–800.

24. Rubiera M, Ribo M, Delgado-Mederos R, Santamarina E, Delgado P, Montaner J et al. Tandem internal carotid artery/middle cerebral artery occlusion: an independent predictor of poor outcome after systemic thrombolysis. Stroke 2006; 37: 2301-5.

25. The NINDS t-PA Stroke Study Group. Generalized Efficacy of t-PA for Acute Stroke: Subgroup Analysis of the NINDS t-PA Stroke Trial. Stroke 1997; 28: 2119-25.

26. Molina CA, Ribo M, Rubiera M, Montaner J, Santamarina E, Delgado-Mederos R et al. Microbubble administration accelerates clot lysis during continuous 2-MHz ultrasound monitoring in stroke patients treated with intravenous tissue plasminogen activator. Stroke 2006; 37: 425-9.

27. Alexandrov AV. Ultrasound enhanced thrombolysis for stroke. International J Stroke 2006; 1: 26–9.

Labels
Paediatric neurology Neurosurgery Neurology

Article was published in

Czech and Slovak Neurology and Neurosurgery

Issue 3

2007 Issue 3

Most read in this issue

This topic is also in:


Login
Forgotten password

Don‘t have an account?  Create new account

Forgotten password

Enter the email address that you registered with. We will send you instructions on how to set a new password.

Login

Don‘t have an account?  Create new account