Handbook on Neurovascular Ultrasound, Therapeutic transcranial doppler sonography

MIKULÍK, Robert and Andrei ALEXANDROV. Handbook on Neurovascular Ultrasound, Therapeutic transcranial doppler sonography. Switzeraland,Basel: Karger, 2006, 11 pp. Front Neurol Neurosci. ISBN 3-8055-8022-3.

Basic information

• Original name: Handbook on Neurovascular Ultrasound, Therapeutic transcranial doppler sonography
• Name in Czech: Terapeutické aplikace transkraniálního ultrazvuku
• Authors: MIKULÍK, Robert (203 Czech Republic, guarantor) and Andrei ALEXANDROV (840 United States of America).
• Edition: Switzeraland,Basel, 11 pp. Front Neurol Neurosci, 2006.
• Publisher: Karger

Other information

• Original language: English
• Type of outcome: Book on a specialized topic
• Field of Study: 30000 3. Medical and Health Sciences
• Country of publisher: Switzerland
• Confidentiality degree: is not subject to a state or trade secret
• WWW: URL
• Organization unit: Faculty of Medicine
• ISBN: 3-8055-8022-3
• Keywords (in Czech): CMP;transkraniální uultrazvuk;terapie
• Keywords in English: stroke;transcranial ultrasound;therapy
• Tags: Stroke, THERAPY, transcranial ultrasound
• Tags: International impact, Reviewed

Abstract

Ultrasound (US) has emerged as a new tool to treat ischemic stroke. The potential advantage of US is decreased risk of systemic bleeding complications due to its site-specific effect. Moreover, external application is noninvasive and is readily available. Experimental studies showed that low intensity (equal or less than 2 W/cm2) US safely enhanced thrombolytic drug activity within a wide range of frequencies (0.04--3.4 MHz). In humans, transcranial sonothrombolysis with mid-kiloHertz frequencies showed an unacceptably high rate of intracranial bleeding, while the use of 2 MHz yielded promising results in The Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic TPA (CLOTBUST) study. This study was a phase II randomized clinical trial that included patients with middle cerebral artery (MCA) occlusion within 3 h of stroke onset, who were treated with standard dose of tissue plasminogen activator (t-PA). Residual flow in MCA was monitored with 2 MHz US in one group, and the rate of complete recanalization and dramatic clinical recovery significantly increased as compared to t-PA alone. This chapter further discusses diagnosis of an acute occlusion and recanalization using the thrombolysis in brain ischemia (TIBI) waveform flow grading scale, application of fast track insonation protocol, and administration of US. Also, the potential enhancement of sonothrombolysis with microbubbles is discussed.

Abstract (in Czech)

Ultrasound (US) has emerged as a new tool to treat ischemic stroke. The potential advantage of US is decreased risk of systemic bleeding complications due to its site-specific effect. Moreover, external application is noninvasive and is readily available. Experimental studies showed that low intensity (equal or less than2 W/cm2) US safely enhanced thrombolytic drug activity within a wide range of frequencies (0.04--3.4 MHz). In humans, transcranial sonothrombolysis with mid-kiloHertz frequencies showed an unacceptably high rate of intracranial bleeding, while the use of 2 MHz yielded promising results in The Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic TPA (CLOTBUST) study. This study was a phase II randomized clinical trial that included patients with middle cerebral artery (MCA) occlusion within 3 h of stroke onset, who were treated with standard dose of tissue plasminogen activator (t-PA). Residual flow in MCA was monitored with 2 MHz US in one group, and the rate of complete recanalization and dramatic clinical recovery significantly increased as compared to t-PA alone. This chapter further discusses diagnosis of an acute occlusion and recanalization using the thrombolysis in brain ischemia (TIBI) waveform flow grading scale, application of fast track insonation protocol, and administration of US. Also, the potential enhancement of sonothrombolysis with microbubbles is discussed.