Sonothrombolysis

Abstract

It has been shown that the significant reduction in disability after acute ischemic stroke (AIS) depends on early recanalization. Recombinant tissue plasminogen activator given within 3 hours improves disability by 30% in 3 months. However, still there are a great number of stroke patients who remained signifcantly disabled with this acute intervention. Currently, numerous strategies are being tested to increase further the recanalization rate in AIS. Sonothrombolysis or adding microsphere, intra-arterial rTPA and mechanical thrombectomy have been tried to increase the recanalization rate hence significant improvement has been reported. The simultaneous ultrasound delivery while administering rTPA known as Sonothrombolysis will be discussed in this lecture. A recently concluded randomized, placebo controlled sonothrombolysis study, the CLOTBUST trial has shown significant recanalization rate as its primary outcome measure. However, long-term disability did not show significant difference against placebo. Another non-significant RCT was carried out utilizing “hands-free” TCD device to deliver ultrasound during thrombolysis. Following these results from several trials; a meta-analysis has shown some signals favoring sonothrombolysis in acute ischemic stroke.