Ultrasound-enhanced thrombolysis for stroke

Clinical significance

Research output: Contribution to journalArticle

44 Citations (Scopus)

Abstract

In the pivotal clinical trials of intravenous tissue plasminogen activator (TPA) therapy for ischemic stroke, a low rate of early arterial recanalization was suspected due to the small numbers of patients who had early dramatic clinical improvement. TPA activity can be enhanced with ultrasound including 2 MHz transcranial Doppler (TCD). TCD can identify residual signals around the thrombus with the thrombolysis in brain ischemia (TIBI) flow grading system and therefore expose more thrombus surface to circulating TPA. A phase I clinical study, monitoring TPA infusion with diagnostic ultrasound resulted in an unexpectedly high rate of complete recanalization (36% of proximal middle cerebral artery (MCA) occlusions) and associated early dramatic clinical recovery (24%) among treated patients. The external application of diagnostic ultrasound in our studies raised the possibility that a synergistic TPA and ultrasound action accelerated flow improvement and achieved faster and more complete thrombus dissolution as predicted from experimental models. The CLOTBUST (combined lysis of thrombus in brain ischemia using transcranial ultrasound and systemic TPA) trial is testing this hypothesis in a phase II clinical randomized multi-center setting. Dramatic clinical recovery from stroke and complete recanalization shortly after TPA bolus are feasible goals for thrombolysis assisted with TCD monitoring.

Original languageEnglish (US)
Pages (from-to)131-140
Number of pages10
JournalEuropean Journal of Ultrasound
Volume16
Issue number1-2
DOIs
StatePublished - Nov 1 2002
Externally publishedYes

Fingerprint

Tissue Plasminogen Activator
strokes
Ultrasonics
Stroke
Tissue
Thrombosis
ischemia
Brain Ischemia
brain
Ultrasonography
Brain
recovery
Recovery
Monitoring
occlusion
Middle Cerebral Artery Infarction
arteries
therapy
dissolving
Dissolution

All Science Journal Classification (ASJC) codes

  • Bioengineering
  • Chemical Engineering(all)
  • Radiology Nuclear Medicine and imaging
  • Acoustics and Ultrasonics

Cite this

Ultrasound-enhanced thrombolysis for stroke : Clinical significance. / Alexandrov, Andrei.

In: European Journal of Ultrasound, Vol. 16, No. 1-2, 01.11.2002, p. 131-140.

Research output: Contribution to journalArticle

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