Ultrasound enhanced thrombolysis for stroke

International Journal of Stroke : Official Journal of the International Stroke Society
Andrei V Alexandrov

Abstract

In the pivotal clinical trials of intravenous tissue plasminogen activator (TPA) therapy, a low rate of early arterial recanalization was suspected because only a few stroke patients may have had early dramatic clinical improvement. Tissue plasminogen activator activity can be enhanced with ultrasound, including 2 MHz transcranial Doppler (TCD). Transcranial Doppler identifies residual blood flow signals around thrombi, and, by delivering mechanical pressure waves, exposes more thrombus surface to circulating TPA. For the first time in clinical medicine, the international multicenter CLOTBUST trial showed that ultrasound enhances the thrombolytic activity of a drug in humans, thereby confirming multidisciplinary experimental research conducted worldwide for the past 30 years. In the CLOTBUST trial, the dramatic clinical recovery from stroke coupled with complete recanalization within 2 h after TPA bolus occurred in 25% of patients treated with TPA+TCD compared with 8% who received TPA alone (P=0.02). Complete clearance of a thrombus and dramatic recovery of brain functions during treatment are feasible goals for ultrasound-enhanced thrombolysis that can lead to sustained recovery. An early boost in brain perfusion seen in the t...Continue Reading

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Citations

Aug 6, 2013·Journal of Cardiovascular Translational Research·Alexander L Klibanov
Jun 30, 2007·Neurotherapeutics : the Journal of the American Society for Experimental NeuroTherapeutics·Georgios Tsivgoulis, Andrei V Alexandrov
Jan 3, 2012·Neurosurgical Focus·Edson Bor-Seng-ShuManoel Jacobsen Teixeira
Jul 6, 2014·Expert Review of Neurotherapeutics·Michal HaršányAndrei V Alexandrov
Nov 11, 2009·Ultrasound in Medicine & Biology·Denise A B SmithChristy K Holland
Oct 13, 2009·Ultrasonics·Kullervo Hynynen
Dec 6, 2008·Neurologic Clinics·Zsolt Garami, Andrei V Alexandrov
May 31, 2008·Ultrasonics·Georgios TsivgoulisAndrei V Alexandrov
Aug 17, 2012·Journal of Magnetic Resonance Imaging : JMRI·Kullervo Hynynen
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Apr 24, 2013·Journal of Neuroimaging : Official Journal of the American Society of Neuroimaging·Maher SaqqurAndrei V Alexandrov
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Jan 1, 2014·Global Cardiology Science & Practice·Ibrahim M El-SherbinyMagdi H Yacoub

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Software Mentioned

CLOTBUST

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