title: Sonothrombolysis for acute ischemic stroke - Break on through to the other side.
abstract: BACKGROUND
  Intravenous (IV) tissue plasminogen activator (tPA) infusion combined with transcranial low-frequency ultrasound waves targeted on the occluded arterial segment (sonothrombolysis) can increase recanalization in large artery-acute ischemic stroke (LA-AIS).
  
  
  OBJECTIVE
  To evaluate the benefits of sonothrombolysis in LA-AIS.
  
  
  METHODS
  An open-labeled observational study done in a quaternary care teaching hospital.
  
  
  METHODS
  Patients with LA-AIS within the window period (<4.5 h) with no contraindications for IV-recombinant tPA were sonothrombolysed. Recanalization was monitored and graded using the transcranial Doppler thrombolysis in brain ischemia (TIBI) flow criteria and also by time of flight magnetic resonance angiography using a modified thrombolysis in myocardial infarction score. Parenchymal changes were assessed using computed tomography (CT) or diffusion-weighted imaging-Alberta Stroke Programme Early CT Score. National Institutes of Health Stroke Scale (NIHSS) and modified Rankin Scale (mRS) were used to assess the outcome.
  
  
  RESULTS
  Eighteen patients underwent sonothrombolysis and the mean onset to needle time was 138 min (range 65-256). TIBI residual flow grade of ≥2 was seen in 15 of 18 patients (83%). Immediate dramatic improvement (NIHSS score ≤3 points or improvement by ≥10 points) was seen in 6 of 18 patients (30%) and in 9 of 18 patients (50%) within the next 24 h. Two patients (one with TIBI 0, another with re-occlusion) underwent mechanical thrombectomy post-sonothrombolysis. Symptomatic hemorrhage occurred in 5.5% of the patients. At 6 months, 2 of 18 patients (11%) died and 10 of 16 patients (63%) achieved mRS ≤2.
  
  
  CONCLUSIONS
  Sonothrombolysis appears to be a safe way to augment the effect of tPA without increasing the door to needle time with the added advantage of observing flow through the occluded artery in real time.
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sanjith
authors.initials: S
authors.lastname: Aaron
authors.affiliation: Department of Radiology, Christian Medical College and Hospital, Vellore, Tamil Nadu, India.
authors.forename: Sunithi
authors.initials: S
authors.lastname: Mani
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: A T
authors.initials: AT
authors.lastname: Prabhakar
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: P Suresh
authors.initials: PS
authors.lastname: Babu
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Sanjeev
authors.initials: S
authors.lastname: Kumar
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Rohith Ninan
authors.initials: RN
authors.lastname: Benjamin
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Ajith
authors.initials: A
authors.lastname: Sivadasan
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Karthik
authors.initials: K
authors.lastname: Muthusamy
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Anil Kumar B
authors.initials: AK
authors.lastname: Patil
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Vivek
authors.initials: V
authors.lastname: Mathew
authors.affiliation: Department of Neurological Sciences, Neurology Unit, Christian Medical College, Vellore, Tamil Nadu, India.
authors.forename: Mathew
authors.initials: M
authors.lastname: Alexander
mesh_terms: D000368:Aged; D002545:Brain Ischemia / Q000188:drug therapy / Q000628:therapy*; D003131:Combined Modality Therapy; D005260:Female; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006784:Hospitals, Teaching; D006801:Humans; D008297:Male; D061185:Mechanical Thrombolysis / Q000379:methods*; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D020521:Stroke / Q000188:drug therapy / Q000628:therapy*; D010959:Tissue Plasminogen Activator / Q000008:administration & dosage*; D000069453:Ultrasonic Waves; D017585:Ultrasonography, Doppler, Transcranial
chemical_list: D005343:Fibrinolytic Agents; D010959:Tissue Plasminogen Activator