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Year : 2017  |  Volume : 65  |  Issue : 1  |  Page : 52--57

Sonothrombolysis for acute ischemic stroke - Break on through to the other side

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

Correspondence Address:
Dr. Mathew Alexander
Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore - 632 004, Tamil Nadu
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/0028-3886.198213

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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.


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