Endovascular sonolysis results in “safe and potentially effective” revascularisation in acute ischaemic stroke

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A small, prospective study, published in the July issue of American Journal of Neuroradiology, showed that sonolysis using the EkoSonic Endovascular system resulted in safe and potentially effective revascularisation in patients experiencing acute ischaemic stroke. Arterial recanalisation after endovascular treatment was achieved in 85.7% patients with middle cerebral artery occlusion and 100% patients with basilar artery occlusions. 

Sonolysis is a new therapeutic procedure for arterial recanalisation and in experimental studies, ultrasound has been shown to aid in dissolving thrombus in a variety of ways.

David Školoudík, Department of Neurology, University Hospital Ostrava, Ostrava, Czech Republic, and team, enrolled fourteen patients, with acute ischaemic stroke with occlusion of the middle cerebral artery or basilar artery consecutively in this study. The cohort was made up of mostly male patients (n=10), aged 65 years on average, with a median NIHSS score of 16.5. The investigators selected a control group (with 44 middle cerebral artery and 12 basilar artery occlusions) from historical controls.

The investigators used the EkoSonic Endovascular System within eight hours after stroke onset. They also evaluated the NIHSS score at hospital admission, after 24 hours, and at seven days. The researchers recorded data on arterial recanalisation, early neurologic improvement, symptomatic intracerebral haemorrhage, and favourable three-month clinical outcome defined as a modified Rankin Scale (mRS) score of 0–2.


Arterial recanalisation after endovascular treatment was achieved in 85.7% (six of seven) patients with middle cerebral artery occlusion and 100% (all seven) patients with basilar artery occlusions.

There were no cases of symptomatic intracerebral haemorrhage or complications during the procedure. Seven (50%) patients were independent at the three-month follow-up (median mRS score=2).

Školoudík and colleagues wrote: “Early neurologic improvement and favourable clinical outcome were significantly more frequent in patients with middle cerebral artery occlusion undergoing sonolysis than in controls (100% and 71.4% vs. 4.6% and 13.6% of patients; p=0.0001 and p=0.003, respectively). Three-month mortality was significantly lower in patients with basilar artery occlusion undergoing sonolysis than in controls (0% versus 66.7% patients, p=0.013).”

 

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