| ORIGINAL ARTICLE
|Year : 2017 | Volume
| Issue : 1 | Page : 52--57
Sonothrombolysis for acute ischemic stroke - Break on through to the other side
Sanjith Aaron1, Sunithi Mani2, AT Prabhakar1, P Suresh Babu1, Sanjeev Kumar1, Rohith Ninan Benjamin1, Ajith Sivadasan1, Karthik Muthusamy1, Anil Kumar B Patil1, Vivek Mathew1, Mathew Alexander1
1 Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India
2 Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India
Background: Intravenous (IV) tissue plasminogen activator (tPA) infusion combined with transcranial low-frequency ultrasound waves targeted on the occluded arterial segment (sonothrombolysis) can increase recanalization in large artery-acute ischemic stroke (LA-AIS).
Aims: To evaluate the benefits of sonothrombolysis in LA-AIS.
Settings and Designs: An open-labeled observational study done in a quaternary care teaching hospital.
Methodology: Patients with LA-AIS within the window period (<4.5 h) with no contraindications for IV-recombinant tPA were sonothrombolysed. Recanalization was monitored and graded using the transcranial Doppler thrombolysis in brain ischemia (TIBI) flow criteria and also by time of flight magnetic resonance angiography using a modified thrombolysis in myocardial infarction score. Parenchymal changes were assessed using computed tomography (CT) or diffusion-weighted imaging-Alberta Stroke Programme Early CT Score. National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the outcome.
Results: Eighteen patients underwent sonothrombolysis and the mean onset to needle time was 138 min (range 65–256). TIBI residual flow grade of ≥2 was seen in 15 of 18 patients (83%). Immediate dramatic improvement (NIHSS score ≤3 points or improvement by ≥10 points) was seen in 6 of 18 patients (30%) and in 9 of 18 patients (50%) within the next 24 h. Two patients (one with TIBI 0, another with re-occlusion) underwent mechanical thrombectomy post-sonothrombolysis. Symptomatic hemorrhage occurred in 5.5% of the patients. At 6 months, 2 of 18 patients (11%) died and 10 of 16 patients (63%) achieved mRS ≤2.
Conclusions: Sonothrombolysis appears to be a safe way to augment the effect of tPA without increasing the door to needle time with the added advantage of observing flow through the occluded artery in real time.
Dr. Mathew Alexander
Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore - 632 004, Tamil Nadu
Source of Support: None, Conflict of Interest: None
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