Neurological

Sonothrombolysis improves the likelihood of complete recanalization in acute ischemic stroke

According to study results published in Stroke, ultrasound-assisted thrombolysis or sonothrombolysis in acute ischemic stroke (AIS) patients with large vessel occlusions (LVO) was associated with an increased likelihood of complete recanalization compared to intravenous thrombolysis.

Previous research on the safety and effectiveness of sonothrombolysis to improve the likelihood of recanalization and beneficial functional outcomes in patients with AIS with LVO has produced conflicting results. A previous large phase 3 randomized controlled clinical trial (RCT) of the safety of sonothrombolytic efficacy compared to intravenous tissue-type plasminogen activator found that sonothrombolytic administration was safe but showed no additional clinical benefit in this patient population. The authors of the current study attempted to analyze individual patient data from RCTs in order to systematically assess the safety and effectiveness of sonothrombolysis with or without the addition of microspheres (small, spherical particles) in patients with AIS with LVO.

The study was a meta-analysis of 7 RCTs with a pooled cohort of 102 patients with AIS and LVO. The studies included in the analysis compared sonothrombolysis (n = 138) with or without the addition of microspheres with intravenous thrombolysis alone (n = 134). The researchers involved in the meta-analysis rated and compared these groups in terms of the rate of complete recanalization 1 to 36 hours after the start of the assigned therapy.

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The patients in the groups with sonothrombolysis and intravenous thrombolysis alone had a median age of 68 and 67 years, respectively. A higher proportion of patients in the sonothrombolysis group consisted of men (66% vs. 51%; P = 0.011).

Patients who received sonothrombolysis had a higher chance of complete recanalization compared to those who were assigned to intravenous thrombolysis alone (40.3% and 22.4%; adjusted odds ratio.) [OR], 2.33; 95% CI, 1.02-5.34). In contrast, there was no significant difference between the two arms in terms of the likelihood of symptomatic intracranial bleeding (7.3% vs. 3.7%; adjusted OR 2.55; 95% CI 0.76–8.52).

Furthermore, there were no differences between the treatment groups with regard to the 3-month favorable functional outcome (adjusted OR 1.43; 95% CI 0.64–3.19) and the 3-month function independence (adjusted OR 1 , 43; 95% CI, 0.77-2.64).

The researchers wrote that while there was a lack of heterogeneity between the studies for all evaluated endpoints, significant differences between the studies with regard to the endpoint definitions were observed, particularly in the case of complete recanalization and symptomatic intracranial bleeding.

Despite this caveat, the researchers wrote that their results “provide preliminary evidence that sonothrombolysis nearly doubles the likelihood of complete recanalization compared to intravenous thrombolysis alone in patients with AIS” and LVO.

Disclosure: Several authors stated links to the pharmaceutical industry. For a full list of the details, see the original article.

reference

Tsivgoulis G, Katsanos AH, Eggers J, et al. Sonothrombolysis in patients with acute ischemic stroke with occlusion of large vessels: an individual patient data meta-analysis. Stroke. Published online August 25, 2021. doi: 10.1161 / STROKEAHA.120.030960

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