The Efficacy of Sonothrombotripsy and Sonothrombolysis on Accelerated Recanalization of the Middle Cerebral Artery

Czech version

Authors: D. Školoudík ^1,2; M. Bar ²; O. Škoda ³; D. Václavík ⁴; P. Hradílek ¹; K. Langová ⁵; R. Herzig ²; P. Kaňovský ²
Authors‘ workplace: Neurologická klinika FNsP Ostrava-Poruba, Ostrava ¹; Iktové centrum, Neurologická klinika LF UP a FN, Olomouc ²; Neurologické oddělení Nemocnice Pelhřimov ³; Neurologické oddělení Vítkovické nemocnice, Ostrava ⁴; Oddělení biometrie, Ústav lékařské biofyziky LF UP, Olomouc ⁵
Published in: Cesk Slov Neurol N 2007; 70/103(3): 248-252
Category: Original Paper

Výsledky studie byly prezentovány formou přednášky na 38th Danube Symposium, Brno, 7. 4. 2006, 32. Česko-slovenském cerebrovaskulárním sympoziu ve Zlíně 17. 6. 2006 a formou posteru na 11th Meeting of ESNCH SRN 15. 5. 2006 v Düsseldorfu, SRN.

Overview

Introduction:
Recent studies have shown probable effects of transcranial ultrasound monitoring on accelerated recanalization of intracranial arteries, both in patients treated with systemic thrombolysis (sonothrombolysis, S-lysis) and in combination with antiaggregation therapy (sonothrombotripsy, S-tripsy). The aim was to compare the efficacy of S-lysis and S-tripsy on the recanalization of the middle cerebral artery (MCA) occlusion inpatients with acute cerebral ischemia.

Patients and Methods:
The study involved patients with acute occlusion of MCA (M1 or M2). S-lysis was applied by 3 hours in 24 patients (5 men, age 58.7 ± 12.9 years, median NIHSS 17 ± 5.1, 18 occlusions of M1) and S-tripsy was used by 12 hours after appearing the signs in 62 patients (41 men, aged 62.9 ± 12.5 years, median NIHSS 14.0 ± 5.7, 44 occlusions of M1). Diagnostic transcranial duplex sonography (TCCS) was carried out at the admission, 1 hour after starting the therapy, 6 and 24 hours after appearing the signs with evaluating the artery occlusion and its successive partial or complete recanalization.

Results:
The following was found out in groups with S-lysis versus S-tripsy: complete/partial recanalization 1 hour after the therapy initiation in 42%/25% vs 26%/56% (p > 0.05), complete recanalization 6/24 hours after appearing the signs in 61%/71% vs 52%/65% (p > 0.05), Symptomatic intracerebral bleeding in 1 (4%) vs 1 (2%) patient, and independency after 90 days (mRS 0-2) in 50% vs 44% patients (p > 0.05). The recanalization velocity was independent on age, sex, time elapsed by the therapy initiation or the application of echocontrast.

Conclusion:
The patients treated with the combination of systemic thrombolysis and transcranial ultrasound monitoring reached nonsignificantly higher number of complete recanalizations of the cerebral artery within the first 24 hours if compared with subjects treated only with sonothrombotripsy.

Key words:
transcranial ultrasound – thrombolysis – cerebrovascular accident – recanalization – a. cerebri media

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