Prognostic relevance of ultra-early doppler sonography in acute ischaemic stroke: a prospective multicentre study

Allendoerfer, J.; Goertler, Michael; Reutern, Gerhard-Michael von

doi:10.1016/s1474-4422(06)70551-8

Cited by 84 publications

(87 citation statements)

References 21 publications

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“…It provides functional and prognostic information valuable for individual patient management (Allendoerfer et al, 2006;Nedelmann et al, 2009;Perren et al, 2006;Wunderlich et al, 2007). Next to diagnostic applications, randomized clinical studies suggest therapeutic efficacy of ultrasound on recanalization of acute cerebral artery occlusion in terms of an acceleration of fibrinolysis with recombinant tissue-type plasminogen activator (rt-PA) (Alexandrov et al, 2004;Eggers et al, 2008).…”

Section: Introductionmentioning

confidence: 99%

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Nedelmann

Ritschel

Doenges

et al. 2010

J Cereb Blood Flow Metab

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In monitoring of recanalization and in sonothrombolysis, contrast-enhanced ultrasound (CEUS) is applied in extended time protocols. As extended use may increase the probability of unwanted effects, careful safety evaluation is required. We investigated the safety profile and beneficial effects of CEUS in a reperfusion model. Wistar rats were subjected to filament occlusion of the right middle cerebral artery (MCA). Reperfusion was established after 90 minutes, followed by recombinant tissue-type plasminogen activator (rt-PA) treatment and randomization to additional CEUS (contrast agent: SonoVue; 60 minutes). Blinded outcome evaluation consisted of magnetic resonance imaging (MRI), neurologic assessment, and histology and, in separate experiments, quantitative 3D nano-computed tomography (CT) angiography (900 nm 3 voxel size). Nano-CT revealed severely compromised microcirculation in untreated animals after MCA reperfusion. The rt-PA partially improved hemispheric perfusion. Impairment was completely reversed in animals receiving rt-PA and CEUS. This combination was more effective than treatment with either CEUS without rt-PA or rt-PA and ultrasound or ultrasound alone. In MRI experiments, CEUS and rt-PA treatment resulted in a significantly reduced ischemic lesion volume and edema formation. No unwanted effects were detected on MRI, histology, and intracranial temperature assessment. This study shows that CEUS and rt-PA is safe in the situation of reperfusion and displays beneficial effects on the level of the microvasculature.

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Section: Introductionmentioning

confidence: 99%

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Nedelmann

Ritschel

Doenges

et al. 2010

J Cereb Blood Flow Metab

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“…An occlusion or severe stenosis of the cerebral arteries can be found in up to 70% to 80% of all ischaemic strokes [7,8]. Because lack of patency correlates closely with poor clinical outcome, it is crucial to achieve recanalization in hyperacute stroke.…”

Section: The Endovascular Approachmentioning

confidence: 99%

Endovascular approaches for acute ischaemic stroke: the current evidence and organizational issues

Kobayashi¹

2012

pwki

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A b s t r a c tStroke is a leading cause of death and the most frequent cause of disability in adults. The specific evidence-based treatments include intravenous thrombolysis, aspirin and stroke unit care. They are associated with a reduction in mortality and increase in the chance of being independent. Endovascular approaches have been emerging as a new option in the management of stroke. They are associated with a higher recanalization rate of intracranial arteries. Several smaller trials have shown that intra-arterial thrombolysis with pro-urokinase can be effective in acute stroke with large artery occlusion, but the drug has been withdrawn from the market. Currently recombinant tissue plasminogen activator (rt-PA) is most widely used for this purpose. Mechanical thrombectomy is a very promising new method with a high recanalization rate. Still its efficacy has not been proven in the settings of randomized controlled trials, which are currently under way. There are several devices commercially available that have been introduced and some of them already approved for use by regulatory authorities. The most frequently used are the MERCI, Penumbra and Solitaire FR devices. The procedures should be performed in a setting of a comprehensive stroke unit. There is an urgent need for creating training systems in neuroendovascular medicine in Europe similar to the American system to provide appropriate care. There is also a great need for randomized clinical trials which will confirm the efficacy of the endovascular strategies for ischaemic stroke.

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“…Several studies described the role of TCD and TCCS as a useful tool for the diagnosis of MCA occlusion and the monitoring of its recanalization and the prognostic value of early arterial recanalization, identified by TCD, was reaffirmed in terms of good outcome at 3 months (Labiche et al 2003) for: -50% of patients with a complete recanalization -44% of patients with a partial recanalization -22% of patient without recanalization In this study 20% of patients with proximal MCA occlusion who do not recanalize within 30 min is dead at 3 months. In the Eligible study (Malferrari et al 2007;Malferrari and Zedde 2008) the subgroup of patients with MCA stenosis or occlusion had the highest recanalization rate and distal MCA lesions shown a better and earlier recanalization and a significantly lower mortality rate than proximal ones, being patent nearly 50% at 3-6 h, as in the NAIS study (Allendoerfer et al 2006). The authors conclude that "in acute stroke patients the early identification of a MCA stenosis or occlusion, mainly distal MCA lesions, is a strong predictor of good functional outcome at 3 months".…”

Section: Monitoring Of Recanalizationmentioning

confidence: 93%

“…Only one of the twelve patients with T occlusion not treated with thrombolysis shown a late spontaneous reperfusion. Also another relevant multicentre study, the NAIS (Study Project of the Neurosonology Research Group of the World Federation of Neurology) (Allendoerfer et al 2006) had the aim of monitoring the vascular status within 6 h from symptoms onset and differentiating the several occlusive pattern in extra-and intracranial circulation. Only 32% of the included patients shown a significant extracranial carotid disease and the conclusion of the authors was that it is unlikely that the success of thrombolysis is independent from vascular status, with a statistical significant difference in recanalization between proximal and distal MCA occlusion.…”

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

“…Also the Eligible study (Malferrari et al 2007) shown that the clinical recovery at both 24 h and 3 months is influenced by the site of occlusion. CLOTBUST (Alexandrov et al 2004b;Saqqur et al 2007), NAIS (Allendoerfer et al 2006) and ELIGIBLE (Malferrari et al 2007;Malferrari and Zedde 2008) studies demonstrated the high predictive value of neurosonology for identifying proximal MCA occlusion. The CLOTBUST authors (Alexandrov et al 2004b;Saqqur et al 2007) proposed TCD as a screening tool for i.v./i.a.…”

Section: Monitoring Of Recanalizationmentioning

confidence: 99%

See 1 more Smart Citation

Neurosonological Evaluation of the Acute Stroke Patients

Malferrari¹,

Zedde²

2011

Neuroimaging for Clinicians - Combining Research and Practice

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Prognostic relevance of ultra-early doppler sonography in acute ischaemic stroke: a prospective multicentre study

Cited by 84 publications

References 21 publications

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Combined Contrast-Enhanced Ultrasound and rt-PA Treatment is Safe and Improves Impaired Microcirculation after Reperfusion of Middle Cerebral Artery Occlusion

Endovascular approaches for acute ischaemic stroke: the current evidence and organizational issues

Neurosonological Evaluation of the Acute Stroke Patients

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