title: The role of sonolysis and sonothrombolysis in acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials and case-control studies.
abstract: OBJECTIVE
  To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke.
  
  
  METHODS
  Electronic databases and grey literature were searched under different MeSH terms from 1970 to present.
  
  
  METHODS
  Randomized control trials (RCTs) and case control studies (CCSs) on sonolysis and sonothrombolysis alone or with microsphere in acute stroke patients (>18 old). Outcome measures included complete recanalization (CR) at 1-2 and 24 hours, 3 months modified Rankin Scale (mRS), and symptomatic intracerebral hemorrhage (sICH). Data was extracted to Review Manager software.
  
  
  RESULTS
  Fifty-seven studies were retrieved and analyzed. Ten studies (7 RCTs and 3 CCSs) were included in our meta-analysis, which revealed that sonolysis and sonothrombolysis are safe (OR of sICH: 1.14; 95% confidence interval (CI): 0.56- 2.34;P=0.71) and effective (OR of CR at 1-2 hours: 2.95;95% CI: 1.81-4.81;P<0.00001) and have more than two-fold higher likelihood of favourable long-term outcome (3-month mRS 0-2; OR: 2.20; CI:1.52-3.19;P<0.0001). Further subgroup analysis based on the presence of microsphere revealed that it is safe (OR of sICH: 1.18; CI:0.433.24;P=0.75) and effective (OR of CR: 2.61; CI: 1.36-4.99;P=0.004). Subgroup analysis based on sonolysis revealed to be safe and effective.
  
  
  CONCLUSIONS
  This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.
authors.affiliation: From the Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.
authors.forename: Maher
authors.initials: M
authors.lastname: Saqqur
authors.forename: Georgios
authors.initials: G
authors.lastname: Tsivgoulis
authors.forename: Francois
authors.initials: F
authors.lastname: Nicoli
authors.forename: David
authors.initials: D
authors.lastname: Skoloudik
authors.forename: Vijay K
authors.initials: VK
authors.lastname: Sharma
authors.forename: Vincent
authors.initials: V
authors.lastname: Larrue
authors.forename: Jürgen
authors.initials: J
authors.lastname: Eggers
authors.forename: Fabienne
authors.initials: F
authors.lastname: Perren
authors.forename: Paris
authors.initials: P
authors.lastname: Charalampidis
authors.forename: Dale
authors.initials: D
authors.lastname: Storie
authors.forename: Ashfaq
authors.initials: A
authors.lastname: Shuaib
authors.forename: Andrei V
authors.initials: AV
authors.lastname: Alexandrov
mesh_terms: D002545:Brain Ischemia / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D016022:Case-Control Studies; D003131:Combined Modality Therapy; D006801:Humans; D061185:Mechanical Thrombolysis / Q000379:methods / Q000706:statistics & numerical data*; D015995:Prevalence; D016032:Randomized Controlled Trials as Topic; D020521:Stroke / Q000000981:diagnostic imaging* / Q000453:epidemiology / Q000628:therapy*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000379:methods / Q000706:statistics & numerical data*; D018084:Ultrasonography, Interventional / Q000706:statistics & numerical data*
keywords: Transcranial Doppler; microsphere; sonolysis; sonothrombolysis