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Does the administration of sonothrombolysis along with tissue plasminogen activator improve outcomes in acute ischemic stroke? A systematic review and meta-analysis

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Abstract

This meta-analysis was conducted to assess the safety and efficacy of sonothrombolysis along with intravenous recombinant tissue plasminogen activator, alteplase (IV rtPA), in the management of acute ischemic stroke. Electronic databases were searched under different meSH terms without the restriction of time and language. 1415 studies were analyzed and seven studies that matched the inclusion criteria were selected. Multiple safety and efficacy outcomes were extracted. Our pooled analysis demonstrated that there is no significant difference between sonothrombolysis group and control group in preventing mortality (RR 1.10 [0.81, 1.50]; p = 0.55; I2 = 0%) and intracranial hemorrhage (RR 1.11 [0.76, 1.63]; p = 0.59; i2 = 0%), however, among the efficacy outcomes; complete recanalization after 60-120 min was achieved more effectively in the sonothrombolysis group (RR 2.11 [1.48, 3.03]; p ≤ 0.0001; I2 = 0%). The rest of the efficacy outcomes like neurological improvement at 24 h (RR 1.20 [0.92, 1.57]; p = 0.18; I2 = 40%) and excellent functional outcome after 3 months (RR 1.19 [0.93, 1.52]; p = 0.17; I2 = 35%) showed no significant differences between the two groups. In subgroup analysis, we found that sonothrombolysis led to a better neurological improvement in patients who were less than 65 years of age (RR 1.20 [0.92, 1.57]; p = 0.05; I2 = 40%). Moreover, there were no significant differences in the following of the subgroups assessed: (a) microsphere or microbubble use, (b) Ultrasound frequency (2 MHz or < 2 MHz), (c) transcranial Doppler (TCD) duration (1 h or 2 h), (d) age (≤ 65 or > 65).

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Funding

Dr. Khosa is the recipient of the Young Investigator Award of Canadian Association of Radiologists (2019).

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Authors and Affiliations

  1. Dow Medical College, Dow University of Health Sciences, Karachi, Pakistan

    Marium Zafar, Roha Saeed Memon & Muhammad Mussa

  2. Spectrum Health, Grand Rapids, MI, USA

    Rameez Merchant

  3. Jinnah Sindh Medical University, Karachi, Pakistan

    Aiman Khurshid

  4. Department of Radiology, Vancouver General Hospital, University of British Columbia, Vancouver, Canada

    Faisal Khosa

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  1. Marium Zafar
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  2. Roha Saeed Memon
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Correspondence to Marium Zafar.

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Zafar, M., Memon, R.S., Mussa, M. et al. Does the administration of sonothrombolysis along with tissue plasminogen activator improve outcomes in acute ischemic stroke? A systematic review and meta-analysis. J Thromb Thrombolysis 48, 203–208 (2019). https://doi.org/10.1007/s11239-019-01899-6

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  • DOI: https://doi.org/10.1007/s11239-019-01899-6

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