The role of sonolysis and sonothrombolysis in acute ischemic stroke: a systematic review and meta-analysis of randomized controlled trials and case-control studies

• Published in: Journal of neuroimaging Vol. 24; no. 3; p. 209
• Main Authors: Saqqur, Maher, Tsivgoulis, Georgios, Nicoli, Francois, Skoloudik, David, Sharma, Vijay K, Larrue, Vincent, Eggers, Jürgen, Perren, Fabienne, Charalampidis, Paris, Storie, Dale, Shuaib, Ashfaq, Alexandrov, Andrei V
• Format: Journal Article
• Language: English
• Published: United States 01.05.2014
• Subjects: Brain Ischemia - diagnostic imaging; Brain Ischemia - epidemiology; Brain Ischemia - therapy; Case-Control Studies; Combined Modality Therapy; Humans; Mechanical Thrombolysis - methods; Mechanical Thrombolysis - statistics & numerical data; Prevalence; Randomized Controlled Trials as Topic; Stroke - diagnostic imaging; Stroke - epidemiology; Stroke - therapy; Treatment Outcome; Ultrasonic Therapy - methods; Ultrasonic Therapy - statistics & numerical data; Ultrasonography, Interventional - statistics & numerical data; sonolysis; sonothrombolysis; microsphere; Transcranial Doppler
• ISSN: 1552-6569
• DOI: 10.1111/jon.12026

To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke. Electronic databases and grey literature were searched under different MeSH terms from 1970 to present. 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. 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. This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.