Sonothrombolysis in the management of acute ischemic stroke

American Journal of Cardiovascular Drugs : Drugs, Devices, and Other Interventions
Marta Rubiera, A V Alexandrov

Abstract

Multiple in vitro and animal models have demonstrated the efficacy of ultrasound to enhance fibrinolysis. Mechanical pressure waves produced by ultrasound energy improve the delivery and penetration of alteplase (recombinant tissue plasminogen activator [tPA]) inside the clot. In human stroke, the CLOTBUST phase II trial showed that the combination of alteplase plus 2 hours of continuous transcranial Doppler (TCD) increased recanalization rates, producing a trend toward better functional outcomes compared with alteplase alone. Other small clinical trials also showed an improvement in clot lysis when transcranial color-coded sonography was combined with alteplase. In contrast, low-frequency ultrasound increased the symptomatic intracranial hemorrhage rate in a clinical trial. Administration of microbubbles (MBs) may further enhance the effect of ultrasound on thrombolysis by lowering the ultrasound-energy threshold needed to induce acoustic cavitation. Initial clinical trials have been encouraging, and a multicenter international study, TUCSON, determined a dose of newly developed MBs that can be safely administered with alteplase and TCD. Even in the absence of alteplase, the ultrasound energy, with or without MBs, could increa...Continue Reading

References

May 1, 1992·Journal of Vascular and Interventional Radiology : JVIR·K Tachibana
Nov 1, 1990·The Journal of the Acoustical Society of America·C K Holland, R E Apfel
Dec 31, 1997·Clinical Cardiology·N C Nanda
Jul 4, 1998·European Journal of Radiology·F CalliadaM G Sommaruga
Sep 16, 1998·Circulation·V SuchkovaC W Francis
Apr 1, 1999·European Journal of Ultrasound : Official Journal of the European Federation of Societies for Ultrasound in Medicine and Biology·S AtarR J Siegel
Mar 13, 2003·Journal of Vascular and Interventional Radiology : JVIR·William C CulpMohammed Moursi
Jun 5, 2003·Annals of Neurology·Jürgen EggersGünter Seidel
Jul 10, 2003·Lancet Neurology·Michael Daffertshofer, Michael Hennerici
Jul 19, 2003·Stroke; a Journal of Cerebral Circulation·J V Bowler
Jul 19, 2003·Stroke; a Journal of Cerebral Circulation·Randall T HigashidaUNKNOWN Technology Assessment Committee of the Society of Interventional Radiology
Jun 29, 2004·European Journal of Echocardiography : the Journal of the Working Group on Echocardiography of the European Society of Cardiology·P A DijkmansO Kamp
Aug 24, 2004·Stroke; a Journal of Cerebral Circulation·William C CulpLouis Marky
Sep 18, 2004·Stroke; a Journal of Cerebral Circulation·Andrei V Alexandrov
Nov 19, 2004·The New England Journal of Medicine·Joseph F Polak
Nov 19, 2004·The New England Journal of Medicine·Andrei V AlexandrovUNKNOWN CLOTBUST Investigators
Dec 14, 2004·Stroke; a Journal of Cerebral Circulation·Stefan PfaffenbergerMichael Gottsauner-Wolf
Feb 5, 2005·Stroke; a Journal of Cerebral Circulation·Jian Wang, Stella E Tsirka
Mar 23, 2005·Neurology·Jürgen EggersInke R König
Jun 7, 2005·Ultrasound in Medicine & Biology·Simon SchäferFrank A Flachskampf
Jun 24, 2005·Ultrasound in Medicine & Biology·Feng XieThomas R Porter
Sep 24, 2005·Stroke; a Journal of Cerebral Circulation·Carlos A Molina, Jeffrey L Saver
Jan 18, 2006·Stroke; a Journal of Cerebral Circulation·Bo Norrving, Robert J Adams
Apr 17, 2007·Ultrasound in Medicine & Biology·Adrian F ProkopRonald A Roy
May 22, 2007·Journal of Thrombosis and Thrombolysis·Fabienne PerrenRoman Sztajzel
May 26, 2007·Stroke; a Journal of Cerebral Circulation·UNKNOWN IMS II Trial Investigators
Jun 30, 2007·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Georgios Tsivgoulis, Andrei V Alexandrov
Sep 29, 2007·Stroke; a Journal of Cerebral Circulation·Didier LeysUNKNOWN Executive Committee of the European Stroke Initiative
May 31, 2008·Ultrasonics·Georgios TsivgoulisAndrei V Alexandrov
Aug 19, 2008·International Journal of Stroke : Official Journal of the International Stroke Society·Maher SaqqurUNKNOWN CLOTBUST-PRO Investigators
Sep 26, 2008·The New England Journal of Medicine·Werner HackeUNKNOWN ECASS Investigators

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Citations

Apr 21, 2012·Journal of Ophthalmology·Shozo SonodaTaiji Sakamoto
Apr 27, 2011·Expert Review of Cardiovascular Therapy·Daniel M Kerr, Kennedy R Lees
Feb 11, 2011·Expert Review of Neurotherapeutics·Alexandre Amaral-SilvaCarlos A Molina
Jul 31, 2013·Neurologic Clinics·Adriana Sofia Ploneda Perilla, Michael J Schneck
Nov 4, 2010·Otolaryngologic Clinics of North America·Michael R Holtel
May 24, 2011·Nanomedicine : Nanotechnology, Biology, and Medicine·Anirban Sen Gupta
Nov 19, 2014·Frontiers in Neurology·Georgios TsivgoulisAndrei V Alexandrov
Apr 12, 2014·The Journal of Pharmacy and Pharmacology·Yan-Ru LiuGuo-Bin Zhang
May 16, 2014·Journal of Neuroscience Research·Pouya A AmeliVishnumurthy Shushrutha Hedna
Sep 22, 2012·Annals of the New York Academy of Sciences·Reza Bavarsad Shahripour, Andrei V Alexandrov
Mar 7, 2021·Molecules : a Journal of Synthetic Chemistry and Natural Product Chemistry·Mostafa MabroukHanan H Beherei
May 12, 2021·Nanomedicine·Vishnu PriyaMadaswamy S Muthu

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