The role of sonolysis and sonothrombolysis in acute ischemic stroke

A systematic review and meta-analysis of randomized controlled trials and case-control studies

Maher Saqqur, Georgios Tsivgoulis, Francois Nicoli, David Skoloudik, Vijay K. Sharma, Vincent Larrue, Jürgen Eggers, Fabienne Perren, Paris Charalampidis, Dale Storie, Ashfaq Shuaib, Andrei Alexandrov

Research output: Contribution to journalReview article

38 Citations (Scopus)

Abstract

OBJECTIVES: To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke. SEARCH METHODS: Electronic databases and grey literature were searched under different MeSH terms from 1970 to present. SELECTION CRITERIA: Randomized control trials (RCTs) and case control studies (CCSs) on sonolysis and sonothrombolysis alone or with microsphere in acute stroke patients (>18 old). Outcome measures included complete recanalization (CR) at 1-2 and 24 hours, 3 months modified Rankin Scale (mRS), and symptomatic intracerebral hemorrhage (sICH). Data was extracted to Review Manager software. RESULTS: Fifty-seven studies were retrieved and analyzed. Ten studies (7 RCTs and 3 CCSs) were included in our meta-analysis, which revealed that sonolysis and sonothrombolysis are safe (OR of sICH: 1.14; 95% confidence interval (CI): 0.56- 2.34;P=0.71) and effective (OR of CR at 1-2 hours: 2.95;95% CI: 1.81-4.81;P<0.00001) and have more than two-fold higher likelihood of favourable long-term outcome (3-month mRS 0-2; OR: 2.20; CI:1.52-3.19;P<0.0001). Further subgroup analysis based on the presence of microsphere revealed that it is safe (OR of sICH: 1.18; CI:0.433.24;P=0.75) and effective (OR of CR: 2.61; CI: 1.36-4.99;P=0.004). Subgroup analysis based on sonolysis revealed to be safe and effective. CONCLUSIONS: This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.

Original languageEnglish (US)
Pages (from-to)209-220
Number of pages12
JournalJournal of Neuroimaging
Volume24
Issue number3
DOIs
StatePublished - Jan 1 2014

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Meta-Analysis
Case-Control Studies
Randomized Controlled Trials
Stroke
Confidence Intervals
Cerebral Hemorrhage
Microspheres
Literature
Software
Outcome Assessment (Health Care)
Databases
Safety
Therapeutics

All Science Journal Classification (ASJC) codes

  • Radiology Nuclear Medicine and imaging
  • Clinical Neurology

Cite this

The role of sonolysis and sonothrombolysis in acute ischemic stroke : A systematic review and meta-analysis of randomized controlled trials and case-control studies. / Saqqur, Maher; Tsivgoulis, Georgios; Nicoli, Francois; Skoloudik, David; Sharma, Vijay K.; Larrue, Vincent; Eggers, Jürgen; Perren, Fabienne; Charalampidis, Paris; Storie, Dale; Shuaib, Ashfaq; Alexandrov, Andrei.

In: Journal of Neuroimaging, Vol. 24, No. 3, 01.01.2014, p. 209-220.

Research output: Contribution to journalReview article

Saqqur, Maher ; Tsivgoulis, Georgios ; Nicoli, Francois ; Skoloudik, David ; Sharma, Vijay K. ; Larrue, Vincent ; Eggers, Jürgen ; Perren, Fabienne ; Charalampidis, Paris ; Storie, Dale ; Shuaib, Ashfaq ; Alexandrov, Andrei. / The role of sonolysis and sonothrombolysis in acute ischemic stroke : A systematic review and meta-analysis of randomized controlled trials and case-control studies. In: Journal of Neuroimaging. 2014 ; Vol. 24, No. 3. pp. 209-220.
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abstract = "OBJECTIVES: To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke. SEARCH METHODS: Electronic databases and grey literature were searched under different MeSH terms from 1970 to present. SELECTION CRITERIA: Randomized control trials (RCTs) and case control studies (CCSs) on sonolysis and sonothrombolysis alone or with microsphere in acute stroke patients (>18 old). Outcome measures included complete recanalization (CR) at 1-2 and 24 hours, 3 months modified Rankin Scale (mRS), and symptomatic intracerebral hemorrhage (sICH). Data was extracted to Review Manager software. RESULTS: Fifty-seven studies were retrieved and analyzed. Ten studies (7 RCTs and 3 CCSs) were included in our meta-analysis, which revealed that sonolysis and sonothrombolysis are safe (OR of sICH: 1.14; 95{\%} confidence interval (CI): 0.56- 2.34;P=0.71) and effective (OR of CR at 1-2 hours: 2.95;95{\%} CI: 1.81-4.81;P<0.00001) and have more than two-fold higher likelihood of favourable long-term outcome (3-month mRS 0-2; OR: 2.20; CI:1.52-3.19;P<0.0001). Further subgroup analysis based on the presence of microsphere revealed that it is safe (OR of sICH: 1.18; CI:0.433.24;P=0.75) and effective (OR of CR: 2.61; CI: 1.36-4.99;P=0.004). Subgroup analysis based on sonolysis revealed to be safe and effective. CONCLUSIONS: This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.",
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T1 - The role of sonolysis and sonothrombolysis in acute ischemic stroke

T2 - A systematic review and meta-analysis of randomized controlled trials and case-control studies

AU - Saqqur, Maher

AU - Tsivgoulis, Georgios

AU - Nicoli, Francois

AU - Skoloudik, David

AU - Sharma, Vijay K.

AU - Larrue, Vincent

AU - Eggers, Jürgen

AU - Perren, Fabienne

AU - Charalampidis, Paris

AU - Storie, Dale

AU - Shuaib, Ashfaq

AU - Alexandrov, Andrei

PY - 2014/1/1

Y1 - 2014/1/1

N2 - OBJECTIVES: To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke. SEARCH METHODS: Electronic databases and grey literature were searched under different MeSH terms from 1970 to present. SELECTION CRITERIA: Randomized control trials (RCTs) and case control studies (CCSs) on sonolysis and sonothrombolysis alone or with microsphere in acute stroke patients (>18 old). Outcome measures included complete recanalization (CR) at 1-2 and 24 hours, 3 months modified Rankin Scale (mRS), and symptomatic intracerebral hemorrhage (sICH). Data was extracted to Review Manager software. RESULTS: Fifty-seven studies were retrieved and analyzed. Ten studies (7 RCTs and 3 CCSs) were included in our meta-analysis, which revealed that sonolysis and sonothrombolysis are safe (OR of sICH: 1.14; 95% confidence interval (CI): 0.56- 2.34;P=0.71) and effective (OR of CR at 1-2 hours: 2.95;95% CI: 1.81-4.81;P<0.00001) and have more than two-fold higher likelihood of favourable long-term outcome (3-month mRS 0-2; OR: 2.20; CI:1.52-3.19;P<0.0001). Further subgroup analysis based on the presence of microsphere revealed that it is safe (OR of sICH: 1.18; CI:0.433.24;P=0.75) and effective (OR of CR: 2.61; CI: 1.36-4.99;P=0.004). Subgroup analysis based on sonolysis revealed to be safe and effective. CONCLUSIONS: This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.

AB - OBJECTIVES: To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke. SEARCH METHODS: Electronic databases and grey literature were searched under different MeSH terms from 1970 to present. SELECTION CRITERIA: Randomized control trials (RCTs) and case control studies (CCSs) on sonolysis and sonothrombolysis alone or with microsphere in acute stroke patients (>18 old). Outcome measures included complete recanalization (CR) at 1-2 and 24 hours, 3 months modified Rankin Scale (mRS), and symptomatic intracerebral hemorrhage (sICH). Data was extracted to Review Manager software. RESULTS: Fifty-seven studies were retrieved and analyzed. Ten studies (7 RCTs and 3 CCSs) were included in our meta-analysis, which revealed that sonolysis and sonothrombolysis are safe (OR of sICH: 1.14; 95% confidence interval (CI): 0.56- 2.34;P=0.71) and effective (OR of CR at 1-2 hours: 2.95;95% CI: 1.81-4.81;P<0.00001) and have more than two-fold higher likelihood of favourable long-term outcome (3-month mRS 0-2; OR: 2.20; CI:1.52-3.19;P<0.0001). Further subgroup analysis based on the presence of microsphere revealed that it is safe (OR of sICH: 1.18; CI:0.433.24;P=0.75) and effective (OR of CR: 2.61; CI: 1.36-4.99;P=0.004). Subgroup analysis based on sonolysis revealed to be safe and effective. CONCLUSIONS: This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.

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DO - 10.1111/jon.12026

M3 - Review article

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