Document Detail


Ultrasound-enhanced thrombolysis for stroke: clinical significance.
MedLine Citation:
PMID:  12470858     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
In the pivotal clinical trials of intravenous tissue plasminogen activator (TPA) therapy for ischemic stroke, a low rate of early arterial recanalization was suspected due to the small numbers of patients who had early dramatic clinical improvement. TPA activity can be enhanced with ultrasound including 2 MHz transcranial Doppler (TCD). TCD can identify residual signals around the thrombus with the thrombolysis in brain ischemia (TIBI) flow grading system and therefore expose more thrombus surface to circulating TPA. A phase I clinical study, monitoring TPA infusion with diagnostic ultrasound resulted in an unexpectedly high rate of complete recanalization (36% of proximal middle cerebral artery (MCA) occlusions) and associated early dramatic clinical recovery (24%) among treated patients. The external application of diagnostic ultrasound in our studies raised the possibility that a synergistic TPA and ultrasound action accelerated flow improvement and achieved faster and more complete thrombus dissolution as predicted from experimental models. The CLOTBUST (combined lysis of thrombus in brain ischemia using transcranial ultrasound and systemic TPA) trial is testing this hypothesis in a phase II clinical randomized multi-center setting. Dramatic clinical recovery from stroke and complete recanalization shortly after TPA bolus are feasible goals for thrombolysis assisted with TCD monitoring.
Authors:
Andrei V Alexandrov
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Publication Detail:
Type:  Clinical Trial; Clinical Trial, Phase I; Journal Article; Research Support, U.S. Gov't, P.H.S.    
Journal Detail:
Title:  European journal of ultrasound : official journal of the European Federation of Societies for Ultrasound in Medicine and Biology     Volume:  16     ISSN:  0929-8266     ISO Abbreviation:  Eur J Ultrasound     Publication Date:  2002 Nov 
Date Detail:
Created Date:  2002-12-09     Completed Date:  2003-04-09     Revised Date:  2007-11-15    
Medline Journal Info:
Nlm Unique ID:  9440414     Medline TA:  Eur J Ultrasound     Country:  Ireland    
Other Details:
Languages:  eng     Pagination:  131-40     Citation Subset:  IM    
Affiliation:
Department of Neurology and Radiology, Houston Medical School, The University of Texas, MSB 7044-6431 Fannin Street, Houston, TX 77030, USA. avalexandrov@att.net
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MeSH Terms
Descriptor/Qualifier:
Brain Ischemia / drug therapy*,  therapy*,  ultrasonography
Combined Modality Therapy
Fibrinolytic Agents / therapeutic use*
Humans
Intracranial Thrombosis / drug therapy*,  therapy*,  ultrasonography
Pilot Projects
Research Design
Stroke / drug therapy*,  therapy*,  ultrasonography
Thrombolytic Therapy
Tissue Plasminogen Activator / therapeutic use*
Treatment Outcome
Ultrasonic Therapy*
Ultrasonography, Doppler, Transcranial
Grant Support
ID/Acronym/Agency:
NS-02229-01/NS/NINDS NIH HHS
Chemical
Reg. No./Substance:
0/Fibrinolytic Agents; EC 3.4.21.68/Tissue Plasminogen Activator

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine


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