title: Endovascular Treatment versus Sonothrombolysis for Acute Ischemic Stroke.
abstract: BACKGROUND
  Currently, there are 2 strategies to increase the effect of systemic thrombolysis with alteplase (rtPA) in acute major stroke: endovascular treatment via stent retrieval and ultrasound enhancement (sonothrombolysis). This study compares these 2 approaches in patients with proximal intracranial occlusion of the anterior circulation.
  
  
  METHODS
  Consecutive data on the treatment outcome of acute middle cerebral artery (M1) or carotid T occlusion were collected from 2 stroke centers: one center used rtPA plus endovascular stent retrieval as standard treatment and the other rtPA plus ultrasound (sonothrombolysis). The primary outcome was functional independence (modified Rankin scale (mRS) 0-2) after neurorehabilitation.
  
  
  RESULTS
  A total of 132 patients were assessed (n = 73 endovascular, n = 59 sonothrombolysis). The rate of functional independence was higher for endovascular treatment (adjusted OR 3.89 (95% CI 1.36-12.58)). Additionally, ordinal mRS analysis favored the endovascular strategy (adjusted common OR 1.70 (95% CI 0.88-3.31)). Subgroup analysis showed that endovascular treatment was superior for carotid T occlusion (adjusted common OR 5.61 (95% CI 1.60-20.93)), but not for middle cerebral artery occlusion (adjusted common OR 1.07 (95% CI 0.47-2.43)). Symptomatic intracerebral hemorrhage occurred in 3 patients from the endovascular group.
  
  
  CONCLUSIONS
  This observational study suggests that endovascular treatment of acute major anterior circulation stroke is superior to sonothrombolysis in terms of functional outcome. This benefit seems to pertain primarily to patients with carotid T occlusion, whereas patients with M1 occlusion seem to profit in a similar way from both methods. (
  
  
  BACKGROUND
  URL: http://www.germanctr.de. Unique identifier: DRKS0000x200B;5305.).
authors.affiliation: Department of Neurology, University Medical Center Freiburg, Freiburg, Germany.
authors.forename: Matthias
authors.initials: M
authors.lastname: Reinhard
authors.forename: Christian A
authors.initials: CA
authors.lastname: Taschner
authors.forename: Nicole
authors.initials: N
authors.lastname: Hörsch
authors.forename: Arthur
authors.initials: A
authors.lastname: Allignol
authors.forename: Christoph J
authors.initials: CJ
authors.lastname: Maurer
authors.forename: Wolf-Dirk
authors.initials: WD
authors.lastname: Niesen
authors.forename: Johann
authors.initials: J
authors.lastname: Lambeck
authors.forename: Claus W
authors.initials: CW
authors.lastname: Wallesch
authors.forename: Horst
authors.initials: H
authors.lastname: Urbach
authors.forename: Cornelius
authors.initials: C
authors.lastname: Weiller
authors.forename: Volker
authors.initials: V
authors.lastname: Schuchardt
authors.forename: Hans-Jörg
authors.initials: HJ
authors.lastname: Griesser-Leute
mesh_terms: D000208:Acute Disease; D000368:Aged; D001925:Brain Damage, Chronic / Q000453:epidemiology / Q000209:etiology; D002545:Brain Ischemia / Q000209:etiology* / Q000534:rehabilitation; D002341:Carotid Artery Thrombosis / Q000150:complications / Q000188:drug therapy / Q000601:surgery / Q000628:therapy*; D003131:Combined Modality Therapy; D057510:Endovascular Procedures; D005260:Female; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006801:Humans; D008297:Male; D008875:Middle Aged; D059906:Neuroimaging; D020127:Recovery of Function; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D016037:Single-Blind Method; D015607:Stents; D017131:Thrombectomy; D015912:Thrombolytic Therapy / Q000379:methods*; D010959:Tissue Plasminogen Activator / Q000627:therapeutic use; D014464:Ultrasonic Therapy
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator