Background and Purpose-Sonothrombolysis is a new treatment approach in acute ischemic stroke. The results of a monocenter, randomized clinical study are presented. Methods-Subjects with acute middle cerebral artery main stem occlusion were randomized into a target group receiving 1-hour transcranial continuous insonation using a 1.8-MHz Doppler ultrasound (US) probe or a control group. All underwent standard thrombolysis with intravenous recombinant tissue-type plasminogen activator. Results-Thirty-seven subjects were included; 19 subjects were treated in the target (US) group and 18 in the control (no-US) group, all with no residual flow in the middle cerebral artery main stem occlusion (Thrombolysis in Brain Ischemia recanalization grade 0). Compared with the no-US group, the US group showed greater improvement in National Institutes of Health Stroke Scale values at days 1 and 4 and a higher median Thrombolysis in Brain Ischemia grade 1 hour after recombinant tissue-type plasminogen activator initiation. Recanalization (complete or partial) after 1 hour occurred in 57.9% of the US group and 22.2% of the no-US group (Pϭ0.045). After 90 days, 4 subjects from the US group had a modified Rankin Score Յ1 (none from the no-US group) and 8 had a Barthel Index Ն95 (none from the no US group; Pϭ0.106 and Pϭ0.003, respectively). Three subjects from the US group (15.8%) developed a symptomatic intracranial hemorrhage as did one (5.6%) in the no-US group (Pϭ0.60). Conclusions-This small randomized study indicates a beneficial impact of transcranial ultrasound on recanalization and short-term outcome in subjects with middle cerebral artery main stem occlusion and recombinant tissue-type plasminogen activator treatment.

We studied the effect of transcranial 2 MHz Doppler ultrasound (US) on the recanalization and outcome of stroke patients suffering from acute middle cerebral artery occlusion. All patients underwent intravenous recombinant tissue-type plasminogen activator thrombolysis. Eleven patients were randomly selected for continuous US monitoring (C-US) over 1 hour; 14 patients were selected for the control group. The C-US group showed a higher grade of recanalization after 1 hour but also a higher number of intraparenchymal bleedings. Overall, a favorable functional outcome occurred more frequently in the C-US group (Barthel index, p = 0.037) after 3 months.

The development of hearing aids incorporates two aspects, namely, the audiological and the technical point of view. The former focuses on items like the recruitment phenomenon, the speech intelligibility of hearing-impaired persons, or just on the question of hearing comfort. Concerning these subjects, different algorithms intending to improve the hearing ability are presented in this paper. These are automatic gain controls, directional microphones, and noise reduction algorithms. Besides the audiological point of view, there are several purely technical problems which have to be solved. An important one is the acoustic feedback. Another instance is the proper automatic control of all hearing aid components by means of a classification unit. In addition to an overview of state-of-the-art algorithms, this paper focuses on future trends.

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Background and Purpose-Ultrasound-enhanced thrombolysis is a promising new approach to facilitate reperfusion therapies for acute ischemic stroke. So far, 3 different ultrasound technologies were used to increase the thrombolytic activity of tissue plasminogen activator (tPA), including transcranial Doppler (TCD), transcranial color-coded duplex (TCCD), and low-frequency ultrasound. We performed a meta-analysis to evaluate the safety and efficacy of ultrasound-enhanced thrombolysis compared to the current standard of care (intravenous tPA). Subjects and Methods-Through Medline, Embase, and Cochrane database search, we identified and abstracted all studies of ultrasound-enhanced thrombolysis in acute cerebral ischemia. Principal investigators were contacted if data not available through peer-reviewed publication were needed. Symptomatic intracerebral hemorrhage (sICH) and recanalization rates were compared between tPA, tPAϩTCDϮmicrospheres (S), tPAϩTCCDϮS, and tPAϩlow-frequency ultrasound. Results-A total of 6 randomized (nϭ224) and 3 nonrandomized (nϭ192) studies were identified. The rates of symptomatic intracerebral hemorrhage in randomized studies were as follows: tPAϩTCD, 3.8% (95% CI, 0%-11.2%); tPAϩTCCD, 11.1% (95% CI, 0%-28.9%); tPAϩlow-frequency ultrasound, 35.7% (95% CI, 16.2%-61.4%); and tPA alone, 2.9% (95% CI, 0%-8.4%). Complete recanalization rates were higher in patients receiving combination of TCD with tPA 37.2% (95% CI, 26.5%-47.9%) compared with patients treated with tPA alone 17.2% (95% CI, 9.5%-24.9%).In 8 trials of high-frequency (TCD/TCCD) ultrasound-enhanced thrombolysis, tPAϩTCD/TCCDϮS was associated with a higher likelihood of complete recanalization (pooled OR, 2.99; 95% CI, 1.70 -5.25; Pϭ0.0001) when compared to tPA alone. High-frequency ultrasound-enhanced thrombolysis was not associated with an increased risk of symptomatic intracerebral hemorrhage (pooled OR, 1.26; 95% CI, 0.44 -3.60; Pϭ0.67). Conclusions-The present safety and signal-of-efficacy data of high-frequency ultrasound-enhanced thrombolysis should be taken into account in the design of future randomized controlled trials. (Stroke. 2010;41:280-287.)

The authors studied the effect of transcranial ultrasound on patients with acute middle cerebral artery occlusion and contraindications for thrombolysis. Fifteen consecutive subjects were randomized for insonation over 1 hour or for inclusion in a control group. By day 4, recanalization and neurologic improvement occurred more frequently in the target group. Ultrasound-induced acceleration of clot dissolution may be an option for patients with contraindications for recombinant tissue plasminogen activator.

This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.

Background Idarucizumab is a monoclonal antibody fragment with high affinity for dabigatran reversing its anticoagulant effects within minutes. Thereby, patients with acute ischemic stroke who are on dabigatran treatment may become eligible for thrombolysis with recombinant tissue-type plasminogen activator (rt-PA). In patients on dabigatran with intracerebral hemorrhage idarucizumab could prevent lesion growth. Aims To provide insights into the clinical use of idarucizumab in patients under effective dabigatran anticoagulation presenting with signs of acute ischemic stroke or intracranial hemorrhage. Methods Retrospective data collected from German neurological/neurosurgical departments administering idarucizumab following product launch from January 2016 to August 2018 were used. Results One-hundred and twenty stroke patients received idarucizumab in 61 stroke centers. Eighty patients treated with dabigatran presented with ischemic stroke and 40 patients suffered intracranial bleeding (intracerebral hemorrhage (ICH) in n = 27). In patients receiving intravenous thrombolysis with rt-PA following idarucizumab, 78% showed a median improvement of 7 points in National Institutes of Health Stroke Scale. No bleeding complications were reported. Hematoma growth was observed in 3 out of 27 patients with ICH. Outcome was favorable with a median National Institutes of Health Stroke Scale improvement of 4 points and modified Rankin score 0–3 in 61%. Six out of 40 individuals (15%) with intracranial bleeding died during hospital stay. Conclusion Administration of rt-PA after reversal of dabigatran activity with idarucizumab in case of acute ischemic stroke seems feasible, effective, and safe. In dabigatran-associated intracranial hemorrhage, idarucizumab appears to prevent hematoma growth and to improve outcome.