Published Online
on March 13, 2008

A more recent version of this article appeared on May 1, 2008

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Submitted on September 4, 2007
Accepted on September 21, 2007

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

Jürgen Eggers MD^*; Inke R. König PhD; Björn Koch MD; Götz Händler MD; and Günter Seidel MD, PhD

From the Department of Neurology (J.E.), Asklepios Hospital Hamburg North, Hamburg, Germany; the Departments of Neurology (G.S.) and Neuroradiology (G.H.) and the Institute of Medical Biometry and Statistics (I.R.K.), University Hospital of Schleswig-Holstein, Campus Lübeck, Lübeck, Germany; and the Department of Neurology (B.K.), Aschaffenburg Hospital, Aschaffenburg, Germany.

^* To whom correspondence should be addressed. E-mail: juergeneggers{at}gmx.net.

Background and Purpose—Sonothrombolysis is a new treatment approach in acute ischemic stroke. The results of a monocenter, randomized clinical study are presented.

Methods—Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a 1.8-MHz Doppler ultrasound (US) probe or a control group. All underwent standard thrombolysis with intravenous recombinant tissue-type plasminogen activator.

Results—Thirty-seven subjects were included; 19 subjects were treated in the target (US) group and 18 in the control (no-US) group, all with no residual flow in the middle cerebral artery main stem occlusion (Thrombolysis in Brain Ischemia recanalization grade 0). Compared with the no-US group, the US group showed greater improvement in National Institutes of Health Stroke Scale values at days 1 and 4 and a higher median Thrombolysis in Brain Ischemia grade 1 hour after recombinant tissue-type plasminogen activator initiation. Recanalization (complete or partial) after 1 hour occurred in 57.9% of the US group and 22.2% of the no-US group (P=0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score 1 (none from the no-US group) and 8 had a Barthel Index 95 (none from the no US group; P=0.106 and P=0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group (P=0.60).

Conclusions—This small randomized study indicates a beneficial impact of transcranial ultrasound on recanalization and short-term outcome in subjects with middle cerebral artery main stem occlusion and recombinant tissue-type plasminogen activator treatment.

Key words: acute • ischemic • stroke • thrombolytic therapy • transcranial ultrasound

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