Sonothrombolysis

is the story (t)old or just the beginning

Zeljko Zivanović, Andrei Alexandrov, Aleksandar Jesić, Petar Slankamenac

Research output: Contribution to journalReview article

3 Citations (Scopus)

Abstract

INTRODUCTION: Intravenous administration of recombinant tissue plasminogen activator, fastest and widely feasible treatment in acute ischemic stroke induces arterial recanalization, a prerequisite for neurological recovery. THE THERAPEUTIC ROLE OF ULTRASOUND AND POTENTIAL MECHANISM OF SONOTHROMBOLYSIS: Augmentation of recanalization can be achieved safely in combination with diagnostic transcranial Doppler by delivering mechanical pressure waves to the thrombus and exposing more thrombus surface to circulating drug. The addition of microspheres can further improve thrombolytic effect.

CLINICAL TRIALS: International multicenter CLOTBUST trial showed that acute ischemic stroke patients treated with sonothrombolysis had higher rate of arterial recanalization and dramatic clinical recovery without increasing risk of symptomatic intracranial hemorrhage. A microsphere dose-escalation study called TUCSON showed that rates of recanalization and clinical recovery tended to be higher in target groups compared with controls. META-ANALYSIS OF CLINICAL TRIALS OF SONOTHROMBOLYSIS: Cochrane Stroke Group found that sonothrombolysis was likely to reduce death or dependency. A meta-analysis of sonothrombolysis showed that patients who received any form of sonothrombolysis had more than twofold higher likelihood of achieving complete arterial recanalization. PERSPECTIVES FOR SONOTHROMBOLYSIS - OPERATOR-INDEPENDENT DEVICE FOR SONOTHROMBOLYSIS: The collaborative group of the CLOTBUST trial designed multi-transducer assembly to cover conventional windows used for transcranial Doppler examinations. Operator-independent device can be quickly mounted by medical personnel with no prior experience in ultrasound. Sonothrombolysis for acute ischemic stroke is now tested in a pivotal efficacy multi-national trial called CLOTBUSTER.

CONCLUSION: Ultrasound is a promising tool to enhance systemic thrombolysis.

Original languageEnglish (US)
Pages (from-to)17-23
Number of pages7
JournalMedicinski Pregled
Volume67
Issue number1-2
DOIs
StatePublished - Jan 1 2014
Externally publishedYes

Fingerprint

Stroke
Microspheres
Meta-Analysis
Thrombosis
Equipment and Supplies
Intracranial Hemorrhages
Tissue Plasminogen Activator
Transducers
Intravenous Administration
Multicenter Studies
Clinical Trials
Pressure
Therapeutics
Pharmaceutical Preparations

All Science Journal Classification (ASJC) codes

  • Medicine(all)

Cite this

Sonothrombolysis : is the story (t)old or just the beginning. / Zivanović, Zeljko; Alexandrov, Andrei; Jesić, Aleksandar; Slankamenac, Petar.

In: Medicinski Pregled, Vol. 67, No. 1-2, 01.01.2014, p. 17-23.

Research output: Contribution to journalReview article

Zivanović, Zeljko ; Alexandrov, Andrei ; Jesić, Aleksandar ; Slankamenac, Petar. / Sonothrombolysis : is the story (t)old or just the beginning. In: Medicinski Pregled. 2014 ; Vol. 67, No. 1-2. pp. 17-23.
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AB - INTRODUCTION: Intravenous administration of recombinant tissue plasminogen activator, fastest and widely feasible treatment in acute ischemic stroke induces arterial recanalization, a prerequisite for neurological recovery. THE THERAPEUTIC ROLE OF ULTRASOUND AND POTENTIAL MECHANISM OF SONOTHROMBOLYSIS: Augmentation of recanalization can be achieved safely in combination with diagnostic transcranial Doppler by delivering mechanical pressure waves to the thrombus and exposing more thrombus surface to circulating drug. The addition of microspheres can further improve thrombolytic effect.CLINICAL TRIALS: International multicenter CLOTBUST trial showed that acute ischemic stroke patients treated with sonothrombolysis had higher rate of arterial recanalization and dramatic clinical recovery without increasing risk of symptomatic intracranial hemorrhage. A microsphere dose-escalation study called TUCSON showed that rates of recanalization and clinical recovery tended to be higher in target groups compared with controls. META-ANALYSIS OF CLINICAL TRIALS OF SONOTHROMBOLYSIS: Cochrane Stroke Group found that sonothrombolysis was likely to reduce death or dependency. A meta-analysis of sonothrombolysis showed that patients who received any form of sonothrombolysis had more than twofold higher likelihood of achieving complete arterial recanalization. PERSPECTIVES FOR SONOTHROMBOLYSIS - OPERATOR-INDEPENDENT DEVICE FOR SONOTHROMBOLYSIS: The collaborative group of the CLOTBUST trial designed multi-transducer assembly to cover conventional windows used for transcranial Doppler examinations. Operator-independent device can be quickly mounted by medical personnel with no prior experience in ultrasound. Sonothrombolysis for acute ischemic stroke is now tested in a pivotal efficacy multi-national trial called CLOTBUSTER.CONCLUSION: Ultrasound is a promising tool to enhance systemic thrombolysis.

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