Sonothrombolysis With Transcranial Color-Coded Sonography and Recombinant Tissue-Type Plasminogen Activator in Acute Middle Cerebral Artery Main Stem Occlusion : Results From a Randomized Study

Sonothrombolysis is a new treatment approach in acute ischemic stroke. The results of a monocenter, randomized clinical study are presented. Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a...

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Veröffentlicht in:Stroke (1970) 2008-05, Vol.39 (5), p.1470-1475
Hauptverfasser: EGGERS, Jiirgen, KÖNIG, Inke R, KOCH, Björn, HÄNDLER, Götz, SEIDEL, Günter
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container_issue 5
container_start_page 1470
container_title Stroke (1970)
container_volume 39
creator EGGERS, Jiirgen
KÖNIG, Inke R
KOCH, Björn
HÄNDLER, Götz
SEIDEL, Günter
description Sonothrombolysis is a new treatment approach in acute ischemic stroke. The results of a monocenter, randomized clinical study are presented. Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a 1.8-MHz Doppler ultrasound (US) probe or a control group. All underwent standard thrombolysis with intravenous recombinant tissue-type plasminogen activator. Thirty-seven subjects were included; 19 subjects were treated in the target (US) group and 18 in the control (no-US) group, all with no residual flow in the middle cerebral artery main stem occlusion (Thrombolysis in Brain Ischemia recanalization grade 0). Compared with the no-US group, the US group showed greater improvement in National Institutes of Health Stroke Scale values at days 1 and 4 and a higher median Thrombolysis in Brain Ischemia grade 1 hour after recombinant tissue-type plasminogen activator initiation. Recanalization (complete or partial) after 1 hour occurred in 57.9% of the US group and 22.2% of the no-US group (P=0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score or=95 (none from the no US group; P=0.106 and P=0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group (P=0.60). This small randomized study indicates a beneficial impact of transcranial ultrasound on recanalization and short-term outcome in subjects with middle cerebral artery main stem occlusion and recombinant tissue-type plasminogen activator treatment.
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The results of a monocenter, randomized clinical study are presented. Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a 1.8-MHz Doppler ultrasound (US) probe or a control group. All underwent standard thrombolysis with intravenous recombinant tissue-type plasminogen activator. Thirty-seven subjects were included; 19 subjects were treated in the target (US) group and 18 in the control (no-US) group, all with no residual flow in the middle cerebral artery main stem occlusion (Thrombolysis in Brain Ischemia recanalization grade 0). Compared with the no-US group, the US group showed greater improvement in National Institutes of Health Stroke Scale values at days 1 and 4 and a higher median Thrombolysis in Brain Ischemia grade 1 hour after recombinant tissue-type plasminogen activator initiation. Recanalization (complete or partial) after 1 hour occurred in 57.9% of the US group and 22.2% of the no-US group (P=0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score &lt;or=1 (none from the no-US group) and 8 had a Barthel Index &gt;or=95 (none from the no US group; P=0.106 and P=0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group (P=0.60). 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Blood coagulation. Reticuloendothelial system</topic><topic>Brain Ischemia - diagnostic imaging</topic><topic>Brain Ischemia - drug therapy</topic><topic>Brain Ischemia - physiopathology</topic><topic>Female</topic><topic>Fibrinolytic Agents - therapeutic use</topic><topic>Humans</topic><topic>Infarction, Middle Cerebral Artery - diagnostic imaging</topic><topic>Infarction, Middle Cerebral Artery - drug therapy</topic><topic>Infarction, Middle Cerebral Artery - physiopathology</topic><topic>Intracranial Hemorrhages - etiology</topic><topic>Intracranial Hemorrhages - physiopathology</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Middle Cerebral Artery - diagnostic imaging</topic><topic>Middle Cerebral Artery - drug effects</topic><topic>Middle Cerebral Artery - physiopathology</topic><topic>Neurology</topic><topic>Pharmacology. Drug treatments</topic><topic>Recombinant Proteins - therapeutic use</topic><topic>Tissue Plasminogen Activator - therapeutic use</topic><topic>Treatment Outcome</topic><topic>Ultrasonography, Doppler, Transcranial - methods</topic><topic>Vascular diseases and vascular malformations of the nervous system</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>EGGERS, Jiirgen</creatorcontrib><creatorcontrib>KÖNIG, Inke R</creatorcontrib><creatorcontrib>KOCH, Björn</creatorcontrib><creatorcontrib>HÄNDLER, Götz</creatorcontrib><creatorcontrib>SEIDEL, Günter</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>Biotechnology Research Abstracts</collection><collection>Technology Research Database</collection><collection>Engineering Research Database</collection><collection>Biotechnology and BioEngineering Abstracts</collection><collection>MEDLINE - Academic</collection><jtitle>Stroke (1970)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>EGGERS, Jiirgen</au><au>KÖNIG, Inke R</au><au>KOCH, Björn</au><au>HÄNDLER, Götz</au><au>SEIDEL, Günter</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Sonothrombolysis With Transcranial Color-Coded Sonography and Recombinant Tissue-Type Plasminogen Activator in Acute Middle Cerebral Artery Main Stem Occlusion : Results From a Randomized Study</atitle><jtitle>Stroke (1970)</jtitle><addtitle>Stroke</addtitle><date>2008-05-01</date><risdate>2008</risdate><volume>39</volume><issue>5</issue><spage>1470</spage><epage>1475</epage><pages>1470-1475</pages><issn>0039-2499</issn><eissn>1524-4628</eissn><coden>SJCCA7</coden><abstract>Sonothrombolysis is a new treatment approach in acute ischemic stroke. The results of a monocenter, randomized clinical study are presented. Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a 1.8-MHz Doppler ultrasound (US) probe or a control group. All underwent standard thrombolysis with intravenous recombinant tissue-type plasminogen activator. Thirty-seven subjects were included; 19 subjects were treated in the target (US) group and 18 in the control (no-US) group, all with no residual flow in the middle cerebral artery main stem occlusion (Thrombolysis in Brain Ischemia recanalization grade 0). Compared with the no-US group, the US group showed greater improvement in National Institutes of Health Stroke Scale values at days 1 and 4 and a higher median Thrombolysis in Brain Ischemia grade 1 hour after recombinant tissue-type plasminogen activator initiation. Recanalization (complete or partial) after 1 hour occurred in 57.9% of the US group and 22.2% of the no-US group (P=0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score &lt;or=1 (none from the no-US group) and 8 had a Barthel Index &gt;or=95 (none from the no US group; P=0.106 and P=0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group (P=0.60). This small randomized study indicates a beneficial impact of transcranial ultrasound on recanalization and short-term outcome in subjects with middle cerebral artery main stem occlusion and recombinant tissue-type plasminogen activator treatment.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams &amp; Wilkins</pub><pmid>18340100</pmid><doi>10.1161/STROKEAHA.107.503870</doi><tpages>6</tpages></addata></record>
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source MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete; Alma/SFX Local Collection
subjects Acute Disease - therapy
Aged
Biological and medical sciences
Blood. Blood coagulation. Reticuloendothelial system
Brain Ischemia - diagnostic imaging
Brain Ischemia - drug therapy
Brain Ischemia - physiopathology
Female
Fibrinolytic Agents - therapeutic use
Humans
Infarction, Middle Cerebral Artery - diagnostic imaging
Infarction, Middle Cerebral Artery - drug therapy
Infarction, Middle Cerebral Artery - physiopathology
Intracranial Hemorrhages - etiology
Intracranial Hemorrhages - physiopathology
Male
Medical sciences
Middle Aged
Middle Cerebral Artery - diagnostic imaging
Middle Cerebral Artery - drug effects
Middle Cerebral Artery - physiopathology
Neurology
Pharmacology. Drug treatments
Recombinant Proteins - therapeutic use
Tissue Plasminogen Activator - therapeutic use
Treatment Outcome
Ultrasonography, Doppler, Transcranial - methods
Vascular diseases and vascular malformations of the nervous system
title Sonothrombolysis With Transcranial Color-Coded Sonography and Recombinant Tissue-Type Plasminogen Activator in Acute Middle Cerebral Artery Main Stem Occlusion : Results From a Randomized Study
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