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Sonothrombolysis: An Emerging Modality for the Treatment of Acute Ischemic and Hemorrhagic Stroke

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Abstract

To date, it is believed that rapid removal of impedances hindering normal blood circulation in the brain would salvage ischemic tissue. Hence, most treatment modalities undergoing clinical evaluation for treatment of stroke are focused on faster recanalization in acute ischemic stroke or faster hematoma mass reduction in hemorrhagic stroke. Therapeutic ultrasound is among the promising emerging modalities being clinically evaluated to meet this purpose. This review provides an overview of existing clinical data in evaluating sonothrombolysis applications in treatment of acute ischemic and hemorrhagic stroke. Furthermore, the present status of clinical evaluation of microbubbles as a potential adjuvant to this modality is reviewed.

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Abbreviations

AIS:

Acute Ischemic Stroke

Barthel Index:

BI

CLEAR:

Evaluating accelerated resolution of intraventricular hemorrhage, rt-PA (Cathflo®) treatment of brain hemorrhage

CLOTBUST:

Combined lysis of thrombus in brain ischemia using transcranial ultrasound and systemic TPA

CT:

X-ray computed tomography

EVD:

External ventricular drain

FDA:

Food and Drug Administration

GCS:

Glascow Coma Scale

HI:

Hemorrhagic infarction

IA:

Intra-arterial

ICH:

Intracerebral hemorrhage

IMS:

Interventional Management of Stroke

IV:

Intravenous

IVH:

Intraventricular hemorrhage

MERCI:

Mechanical Embolus Removal in Cerebral Embolism

MISTIE:

Minimally Invasive Surgery Plus t-PA for Intracerebral Hemorrhage Evacuation

MRI:

Magnetic resonance imaging

mRS:

Modified Rankin Scale

NIHSS:

National Institutes of Health Stroke Scale

NINDS:

National Institute of Neurological Disorders and Stroke

rt-PA:

Recombinant tissue plasminogen activator

SEM:

Standard error of mean

sICH:

Symptomatic intracerebral hemorrhage

SLEUTH:

Safety of Lysis with EKOS Ultrasound in the Treatment of ICH and ICH

TCCD:

Transcranial color-coded Doppler

TCCS:

Transcranial color-coded sonography

TCD:

Transcranial Doppler

TRUMBI:

Transcranial Low-Frequency Ultrasound-Mediated Thrombolysis in Brain Ischemia

TUSCAN:

Transcranial Ultrasound in Clinical Sonothrombolysis

UCA:

Ultrasound contrast agent

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Disclosure

Drs. Soltani and Hansmann are employed by the EKOS Corporation as of the time of submission of this manuscript. Dr. Clark is an occasional consultant on NIH-awarded research projects to EKOS Corporation.

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  1. Research and Development Department, EKOS Corporation, 11911 N Creek Parkway S, Bothell, WA, 98011, USA

    Azita Soltani & Douglas R. Hansmann

  2. Oregon Stroke Center, Oregon Health Sciences University, Portland, OR, USA

    Wayne M. Clark

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  1. Azita Soltani
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Soltani, A., Clark, W.M. & Hansmann, D.R. Sonothrombolysis: An Emerging Modality for the Treatment of Acute Ischemic and Hemorrhagic Stroke. Transl. Stroke Res. 2, 159–170 (2011). https://doi.org/10.1007/s12975-011-0077-1

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