Sonothrombolysis for Acute Ischemic Stroke
2013; Lippincott Williams & Wilkins; Volume: 44; Issue: 2 Linguagem: Inglês
10.1161/strokeaha.111.000043
ISSN1524-4628
AutoresStefano Ricci, Lavinia Dinia, Massimo Del Sette, Gian Paolo Anzola, Tatiana Mazzoli, Silvia Cenciarelli, Carlo Gandolfo,
Tópico(s)Acute Ischemic Stroke Management
ResumoHomeStrokeVol. 44, No. 2Sonothrombolysis for Acute Ischemic Stroke Free AccessResearch ArticlePDF/EPUBAboutView PDFView EPUBSections ToolsAdd to favoritesDownload citationsTrack citationsPermissions ShareShare onFacebookTwitterLinked InMendeleyReddit Jump toFree AccessResearch ArticlePDF/EPUBSonothrombolysis for Acute Ischemic Stroke Stefano Ricci, MD, FRCP-Ed, Lavinia Dinia, MD, Massimo Del Sette, MD, Gian Paolo Anzola, MD, Tatiana Mazzoli, MD, Silvia Cenciarelli, MD and Carlo Gandolfo, MD Stefano RicciStefano Ricci From the UO Neurologia, ASL 1 of Umbria, Citta di Castello, Perugia, Italy (S.R., T.M., S.C.); Department of Neurosciences, Ophtalmology and Genetics; University of Genova, Genova, Italy (M.D.S., L.D., C.G.); and Service of Neurology, S. Orsola Hospital FBF, Bresica, Italy (G.P.A.). , Lavinia DiniaLavinia Dinia From the UO Neurologia, ASL 1 of Umbria, Citta di Castello, Perugia, Italy (S.R., T.M., S.C.); Department of Neurosciences, Ophtalmology and Genetics; University of Genova, Genova, Italy (M.D.S., L.D., C.G.); and Service of Neurology, S. Orsola Hospital FBF, Bresica, Italy (G.P.A.). , Massimo Del SetteMassimo Del Sette From the UO Neurologia, ASL 1 of Umbria, Citta di Castello, Perugia, Italy (S.R., T.M., S.C.); Department of Neurosciences, Ophtalmology and Genetics; University of Genova, Genova, Italy (M.D.S., L.D., C.G.); and Service of Neurology, S. Orsola Hospital FBF, Bresica, Italy (G.P.A.). , Gian Paolo AnzolaGian Paolo Anzola From the UO Neurologia, ASL 1 of Umbria, Citta di Castello, Perugia, Italy (S.R., T.M., S.C.); Department of Neurosciences, Ophtalmology and Genetics; University of Genova, Genova, Italy (M.D.S., L.D., C.G.); and Service of Neurology, S. Orsola Hospital FBF, Bresica, Italy (G.P.A.). , Tatiana MazzoliTatiana Mazzoli From the UO Neurologia, ASL 1 of Umbria, Citta di Castello, Perugia, Italy (S.R., T.M., S.C.); Department of Neurosciences, Ophtalmology and Genetics; University of Genova, Genova, Italy (M.D.S., L.D., C.G.); and Service of Neurology, S. Orsola Hospital FBF, Bresica, Italy (G.P.A.). , Silvia CenciarelliSilvia Cenciarelli From the UO Neurologia, ASL 1 of Umbria, Citta di Castello, Perugia, Italy (S.R., T.M., S.C.); Department of Neurosciences, Ophtalmology and Genetics; University of Genova, Genova, Italy (M.D.S., L.D., C.G.); and Service of Neurology, S. Orsola Hospital FBF, Bresica, Italy (G.P.A.). and Carlo GandolfoCarlo Gandolfo From the UO Neurologia, ASL 1 of Umbria, Citta di Castello, Perugia, Italy (S.R., T.M., S.C.); Department of Neurosciences, Ophtalmology and Genetics; University of Genova, Genova, Italy (M.D.S., L.D., C.G.); and Service of Neurology, S. Orsola Hospital FBF, Bresica, Italy (G.P.A.). Originally published3 Jan 2013https://doi.org/10.1161/STROKEAHA.111.000043Stroke. 2013;44:e6–e7Other version(s) of this articleYou are viewing the most recent version of this article. Previous versions: January 1, 2013: Previous Version 1 IntroductionSeveral studies have consistently demonstrated the capability of ultrasound to enhance the lysis of intra-arterial thrombi in acute ischemic stroke during systemic intravenous thrombolysis with tissue plasimogen activator (tPA), an intervention also called sonothrombolysis.Material and MethodsObjectivesTo quantify the potential benefits of sonothrombolysis in acute ischemic stroke.To quantify the potential harms of sonothrombolysis.Types of StudiesRandomized controlled trials with clear allocation concealment.Types of ParticipantsPatients admitted to hospital with acute ischemic stroke.Types of InterventionsSonothrombolysis versus intravenous tPA therapy alone or conventional treatment.Primary OutcomesSurvival free of significant disability at the end of follow-up.Secondary OutcomesCase fatality, vessel recanalization, symptomatic and asymptomatic hemorrhagic transformation, and cerebral hemorrhage.ResultsWe included 5 studies, with a total of 233 patients randomized. However, not all patients were available for all outcomes: for instance, follow-up at 3 months (death and dependency) was available for 206 patients (88.4%). Three studies used transcranial color-coded duplex, and 2 used transcranial color doppler. The duration of sonothrombolysis varied from 1 to 2 hours. When we considered all the 5 studies, we observed a statistically significant difference for the primary outcome (death or disability at 3 months; 206 patients; odds ratio, 0.50; 95% confidence interval [CI], 0.27–0.91). Results for death were neutral (206 patients; odds ratio, 1.00; 95% CI, 0.46–2.16); failure to recanalize was lower in the sonothrombolysis group (230 patients; odds ratio, 0.28; 95% CI, 0.16–0.50); and there was a nonsignificant trend for increasing cerebral hemorrhages (233 patients; odds ratio, 2.35; 95% CI, 0.95–5.80). When including patients only treated with tPA, the results were very similar.ConclusionsOur results indicate that sonothrombolysis performed in patients with recent onset ischemic stroke with evidence of middle cerebral artery or posterior cerebral artery occlusion produces a significant increase in the recanalization rate (Figure), associated with a nonsignificant increase of hemorrhagic transformation of the cerebral infarction. There was a statistically significant clinical improvement at the 3-month follow-up in terms of death plus disability rate, although with very wide CIs.Download figureDownload PowerPointFigure. Failure to recanalize. CI indicates confidence interval.Implications for PracticeThere is insufficient evidence to establish the effectiveness and safety of sonothrombolysis in routine clinical practice.Implications for ResearchSonothrombolysis is a promising technique but there is a clear need for a new multicenter randomized trial.AcknowledgmentsWe thank Prof Peter Langhorne and the editorial team in Edinburgh for their help.DisclosuresNone.FootnotesCorrespondence to Stefano Ricci, UO Neurologia, Ospedale, Via Engels, ASL 1 of Umbria, Citta di Castello, Perugia 06012, Italy. E-mail [email protected]Reference1. Ricci S, Dinia L, Del Sette M, Anzola P, Mazzoli T, Cenciarelli S, Gandolfo C. Sonothrombolysis for acute ischemic stroke. Cochrane database of systematic reviews. 2012; 10:Art. No. CD008348. DOI 10.1002/14651858.CD008348.pub2. http://dx.doi.org/10.102/14651858.CD008342. Accessed November 15, 2012.Google Scholar Previous Back to top Next FiguresReferencesRelatedDetailsCited By Zhang B, Wu H, Goel L, Kim H, Peng C, Kim J, Dayton P, Gao Y and Jiang X (2021) Magneto-sonothrombolysis with combination of magnetic microbubbles and nanodroplets, Ultrasonics, 10.1016/j.ultras.2021.106487, 116, (106487), Online publication date: 1-Sep-2021. Kate M, Parthasarathy R and Shuaib A (2016) Intravenous Thrombolysis and Anti-thrombotics Ischemic Stroke Therapeutics, 10.1007/978-3-319-17750-2_3, (13-25), . Berkhemer O, Kamalian S, González R, Majoie C and Yoo A (2013) Imaging Biomarkers for Intra-arterial Stroke Therapy, Cardiovascular Engineering and Technology, 10.1007/s13239-013-0148-4, 4:4, (339-351), Online publication date: 1-Dec-2013. February 2013Vol 44, Issue 2 Advertisement Article InformationMetrics © 2013 American Heart Association, Inc.https://doi.org/10.1161/STROKEAHA.111.000043 Manuscript receivedNovember 2, 2012Manuscript acceptedDecember 13, 2012Originally publishedJanuary 3, 2013 KeywordssonothrombolysisrecanalizationhemorrhagePDF download Advertisement SubjectsTreatment
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