Acute stroke

therapeutic transcranial Doppler sonography.

R. Mikulik, Andrei Alexandrov

Research output: Contribution to journalReview article

7 Citations (Scopus)

Abstract

Ultrasound (US) has emerged as a new tool to treat ischemic stroke. The potential advantage of US is decreased risk of systemic bleeding complications due to its site-specific effect. Moreover, external application is noninvasive and is readily available. Experimental studies showed that low intensity (<or=2W/cm2) US safely enhanced thrombolytic drug activity within a wide range of frequencies (0.04-3.4 MHz). In humans, transcranial sonothrombolysis with mid-kHz frequencies showed an unacceptably high rate of intracranial bleeding, while the use of 2MHz yielded promising results in The Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic TPA (CLOTBUST) study. This study was a phase II randomized clinical trial that included patients with middle cerebral artery (MCA) occlusion within 3 h of stroke onset, who were treated with standard dose of tissue plasminogen activator (t-PA). Residual flow in MCA was monitored with 2MHz US in one group, and the rate of complete recanalization and dramatic clinical recovery significantly increased as compared to t-PA alone. This chapter further discusses diagnosis of an acute occlusion and recanalization using the thrombolysis in brain ischemia (TIBI) waveform flow grading scale, application of fast track insonation protocol, and administration of US. Also, the potential enhancement of sonothrombolysis with microbubbles is discussed.

Original languageEnglish (US)
Pages (from-to)150-161
Number of pages12
JournalFrontiers of Neurology and Neuroscience
Volume21
StatePublished - Jan 1 2006
Externally publishedYes

Fingerprint

Doppler Transcranial Ultrasonography
Tissue Plasminogen Activator
Brain Ischemia
Stroke
Hemorrhage
Microbubbles
Phase II Clinical Trials
Fibrinolytic Agents
Middle Cerebral Artery Infarction
Middle Cerebral Artery
Thrombosis
Randomized Controlled Trials
Therapeutics

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Acute stroke : therapeutic transcranial Doppler sonography. / Mikulik, R.; Alexandrov, Andrei.

In: Frontiers of Neurology and Neuroscience, Vol. 21, 01.01.2006, p. 150-161.

Research output: Contribution to journalReview article

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