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Sonothrombolysis for acute ischaemic stroke.

Stefano Ricci1, Lavinia Dinia, Massimo Del Sette

  • 1UO Neurologia, ASL 1 dell’ Umbria, Città di Castello, Italy. stefano.ricci@asl1.umbria.it

The Cochrane Database of Systematic Reviews
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Sonothrombolysis, a treatment for acute ischemic stroke using ultrasound, may reduce death or disability. This method also improves recanalization rates without increasing hemorrhage risk, warranting further investigation.

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Area of Science:

  • Neurology
  • Interventional Cardiology
  • Medical Imaging

Background:

  • Sonothrombolysis is an emerging treatment for acute ischemic stroke, but its efficacy and safety remain under investigation.
  • Debate continues regarding the optimal ultrasound parameters, the use of microbubbles, and the overall effectiveness of sonothrombolysis.

Purpose of the Study:

  • To evaluate the effectiveness and safety of sonothrombolysis in patients experiencing acute ischemic stroke.
  • To synthesize evidence from randomized controlled trials comparing sonothrombolysis with conventional treatments.

Main Methods:

  • A systematic literature search was conducted across multiple databases (Cochrane Stroke Group, MEDLINE, EMBASE, DARE, etc.) up to November 2011.
  • Randomized trials involving sonothrombolysis (with or without microbubbles) initiated within 12 hours of symptom onset were included.
  • Independent data extraction and quality assessment were performed by two reviewers.

Main Results:

  • Five studies with 233 patients were analyzed.
  • Sonothrombolysis treatment demonstrated a significant reduction in death or dependency at three months (OR 0.50, 95% CI 0.27 to 0.91).
  • Recanalization failure was lower in the sonothrombolysis group (OR 0.28, 95% CI 0.16 to 0.50), with no significant differences in mortality or cerebral hemorrhage.

Conclusions:

  • Sonothrombolysis shows potential in reducing death or dependency following acute ischemic stroke, with improved recanalization rates.
  • The observed benefits were achieved without a clear increase in the risk of cerebral hemorrhage.
  • Larger clinical trials are recommended to further validate these findings and establish sonothrombolysis as a standard treatment.