on December 9, 2004
Published online before print December 9, 2004, doi: 10.1161/01.STR.0000150503.10480.a7
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Submitted on September 4, 2004
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. * To whom correspondence should be addressed. 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.
Revised on October 12, 2004
Accepted on October 19, 2004
Can a Commercial Diagnostic Ultrasound Device Accelerate Thrombolysis? An In Vitro Skull Model
Stefan Pfaffenberger MD;
Key words: middle cerebral artery • stroke • thrombolysis • ultrasonography, Doppler, trnascranial
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