Microbubble potentiated transcranial duplex ultrasound enhances IV thrombolysis in acute stroke.
BACKGROUND
We studied whether 2 MHz transcranial color-coded duplex ultrasound (TCCD), combined with a second generation ECA, accelerate IV rtPA-thrombolysis in the acute phase of MCA stroke more than TCCD monitoring alone.


METHODS
Non-randomized acute MCA stroke patients undergoing IV rtPA-thrombolysis and 2 MHZ-TCCD monitoring over 60 min, with (N = 11) or without (N = 15) additional continuous ECA (5 ml, SonoVue perfusion, were compared. Recanalization of the MCA was measured pre- and post-thrombolysis with the thrombolysis in brain ischemia (TIBI) grading system, clinical outcome was assessed at admission and 24 h after treatment using the NIH stroke scale (NIHSS).


RESULTS
Patients who received ECA improved their NIHSS significantly more than those who were only TCCD monitored (Mann-Whitney U = 48.0; P = 0.050), and their flow signal improved more (Mann-Whitney U = 40.0; P < 0.03).


CONCLUSIONS
The results of this pilot study show that in IV-thrombolysis the use of ECA in addition to TCCD monitoring lead to a greater immediate clinical improvement and to a better flow signal.
Perren
Fabienne
F
Department of Neurology, Neurosonology Unit, HUG, University Hospital and Medical School of Geneva, Micheli-du-Crest 24, 1211 Geneva 14, Switzerland. fabienneperren@yahoo.com
Loulidi
Jaouad
J
Poglia
Davide
D
Landis
Theodor
T
Sztajzel
Roman
R
D000368:Aged; D005260:Female; D006801:Humans; D020244:Infarction, Middle Cerebral Artery / Q000000981:diagnostic imaging / Q000188:drug therapy*; D008297:Male; D045423:Microbubbles; D010743:Phospholipids / Q000627:therapeutic use; D013459:Sulfur Hexafluoride / Q000627:therapeutic use; D015912:Thrombolytic Therapy; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use*; D018615:Ultrasonography, Doppler, Color
D010743:Phospholipids; C420843:contrast agent BR1; D010959:Tissue Plasminogen Activator; D013459:Sulfur Hexafluoride