Do bubble characteristics affect recanalization in stroke patients treated with microbubble-enhanced...

Area of Science:

• Neurology
• Biomedical Engineering
• Radiology

Background:

• Microbubbles (MB) may improve ultrasound-enhanced systemic thrombolysis for acute stroke.
• Bubble characteristics might influence sonothrombolysis efficacy.
• Comparing different MB types is crucial for optimizing stroke treatment.

Purpose of the Study:

• To compare the effects of galactose-based air-filled MB (Levovist) and sulfur hexafluoride-filled MB (Sonovue) on recanalization and clinical outcomes in acute stroke.
• To evaluate the impact of MB structural characteristics on ultrasound-enhanced thrombolysis.
• To assess the safety and efficacy of two distinct microbubble agents in stroke patients.

Main Methods:

• 138 i.v. recombinant tissue plasminogen activator (tPA)-treated patients with middle cerebral artery (MCA) occlusion were studied.
• Transcranial Doppler (TCD) monitored arterial occlusion and recanalization (RE) using the thrombolysis in brain ischemia (TIBI) grading system.
• Patients received three bolus of Levovist or Sonovue MB during continuous TCD monitoring.

Main Results:

• Recanalization rates after 1, 2, and 6 hours were similar between Levovist and Sonovue groups (p > 0.3).
• Clinical improvement at 24 hours, symptomatic intracranial hemorrhage rates, and in-hospital mortality were comparable between the two MB groups.
• Long-term outcomes, including functional independence (modified Rankin Scale ≤ 2) at 3 months, were similar regardless of MB type administered.

Conclusions:

• Microbubble administration during sonothrombolysis is associated with high recanalization rates in acute stroke.
• Galactose-based air-filled MB (Levovist) and sulfur hexafluoride-filled MB (Sonovue) demonstrate comparable efficacy and safety profiles.
• The choice of microbubble agent does not significantly impact recanalization rates, clinical course, or long-term outcomes in ultrasound-enhanced thrombolysis for stroke.