This Article Full Text Full Text (PDF) All Versions of this Article: 36/1/124    most recent 01.STR.0000150503.10480.a7v1 Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Pfaffenberger, S. Articles by Gottsauner-Wolf, M. Search for Related Content PubMed PubMed Citation Articles by Pfaffenberger, S. Articles by Gottsauner-Wolf, M. Pubmed/NCBI databases Substance via MeSH Medline Plus Health Information Stroke Related Collections Thrombolysis Other Stroke Treatment - Medical Arterial thrombosis Acute Cerebral Infarction Acute Stroke Syndromes Fibrinolysis

(Stroke. 2005;36:124.)
© 2005 American Heart Association, Inc.

Original Contributions

Can a Commercial Diagnostic Ultrasound Device Accelerate Thrombolysis?

An In Vitro Skull Model

Stefan Pfaffenberger, MD; Branka Devcic-Kuhar, PhD; Christian Kollmann, PhD; Stefan P. Kastl; Christoph Kaun; Walter S. Speidl, MD; Thomas W. Weiss, MD; Svitlana Demyanets, MD; Robert Ullrich, MD; Heinz Sochor, MD; Christian Wöber, MD; Josef Zeitlhofer, MD, PhD; Kurt Huber, MD; Martin Gröschl, PhD; Ewald Benes, PhD; Gerald Maurer, MD; Johann Wojta, PhD Michael Gottsauner-Wolf, MD

From the Departments of Internal Medicine II (S.P., S.P.K., C. Kaun, W.S.S., T.W.W., S.D., H.S., K.H., G.M., J.W., M.G.-W.), Biomedical Engineering and Physics (C. Kollman), Pathology (R.U.), and Neurology (C.W., J.Z.), University of Vienna, Austria; and Institute of General Physics (B.D.-K., M.G., E.B.), Vienna University of Technology, Austria.

Correspondence to Dr Michael Gottsauner-Wolf, Department of Internal Medicine II, University of Vienna, A-1090 Vienna, Waehringer Guertel 18-20, Austria. E-mail michael.gottsauner-wolf{at}univie.ac.at

Background and Purpose— Recently, 3 clinical trials revealed encouraging results in recanalization and clinical outcome in acute stroke patients when 2-MHz transcranial Doppler monitoring was applied. This study investigated whether a 1.8-MHz commercial diagnostic ultrasound device has the potential to facilitate thrombolysis using an in vitro stroke model.

Methods— Duplex-Doppler, continuous wave-Doppler, and pulsed wave (PW)-Doppler were compared on their impact on recombinant tissue plasminogen activator (rtPA)–mediated thrombolysis. Blood clots were transtemporally sonicated in a human stroke model. Furthermore, ultrasound attenuation of 5 temporal bones of different thickness was determined.

Results— In comparison, only PW-Doppler accelerated rtPA–mediated thrombolysis significantly. Without temporal bone, PW-Doppler plus rtPA showed a significant enhancement in relative clot weight loss of 23.7% when compared with clots treated with rtPA only (33.9±5.5% versus 27.4±5.2%; P<0.0005). Ultrasound attenuation measurements revealed decreases of the output intensity of 86.8% (8.8 dB) up to 99.2% (21.2 dB), depending on temporal bone thickness (1.91 to 5.01 mm).

Conclusion— Without temporal bone, PW-Doppler significantly enhanced thrombolysis. However, because of a high attenuation of ultrasound by temporal bone, no thrombolytic effect was observed in our in vitro model, although Doppler imaging through the same temporal bone was still possible.

Key Words: middle cerebral artery • stroke • thrombolysis • ultrasonography, Doppler, trnascranial

This article has been cited by other articles:

				J. Eggers, I. R. Konig, B. Koch, G. Handler, and G. Seidel Sonothrombolysis With Transcranial Color-Coded Sonography and Recombinant Tissue-Type Plasminogen Activator in Acute Middle Cerebral Artery Main Stem Occlusion: Results From a Randomized Study Stroke, May 1, 2008; 39(5): 1470 - 1475. [Abstract] [Full Text] [PDF]

				M. Reinhard, T. Els, and A. Hetzel Response to Letter by Gerriets et al Stroke, February 1, 2007; 38(2): 252 - 252. [Full Text] [PDF]

				F. Schneider, T. Gerriets, M. Walberer, C. Mueller, R. Rolke, B. M. Eicke, J. Bohl, O. Kempski, M. Kaps, G. Bachmann, et al. Brain Edema and Intracerebral Necrosis Caused by Transcranial Low-Frequency 20-kHz Ultrasound: A Safety Study in Rats Stroke, May 1, 2006; 37(5): 1301 - 1306. [Abstract] [Full Text] [PDF]

				S. Pfaffenberger, J. Wojta, and M. Gottsauner-Wolf High-Frequency Transtemporal Sonothrombolysis Stroke, July 1, 2005; 36(7): 1356 - 1357. [Full Text] [PDF]

				M. Daffertshofer, A. Gass, P. Ringleb, M. Sitzer, U. Sliwka, T. Els, O. Sedlaczek, W. J. Koroshetz, and M. G. Hennerici Transcranial Low-Frequency Ultrasound-Mediated Thrombolysis in Brain Ischemia: Increased Risk of Hemorrhage With Combined Ultrasound and Tissue Plasminogen Activator: Results of a Phase II Clinical Trial Stroke, July 1, 2005; 36(7): 1441 - 1446. [Abstract] [Full Text] [PDF]

				S. Meairs, C.-E. Dempfle, S. Pfaffenberger, W. S. Speidl, J. Wojta, and M. Gottsauner-Wolf In Vitro Models for Assessing Transcranial Ultrasound-Enhanced Thrombolysis * Response: Stroke, May 1, 2005; 36(5): 929 - 931. [Full Text] [PDF]