Safety and Efficacy of Endovascular Sonolysis Using the EkoSonic Endovascular System in Patients with Acute Stroke

Kuliha, Martin; Roubec, Martin; Jonszta, Tomáš; Krajča, Jan; Czerný, Daniel; Krajina, Antonı́n; Langová, Kateřina; Herzig, Roman; Procházka, Václav; Školoudík, David

doi:10.3174/ajnr.a3416

Cited by 10 publications

(6 citation statements)

References 45 publications

(63 reference statements)

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“…High morbidity (28.4%) and mortality (8.4%) were observed in PCS patients in our study, even after standard IVT, which was consistent with the results of previous studies (Kumar et al, ; Lindsberg et al, ). However, the optimal interventions for PCS are still uncertain (Powers et al, ) and could include IVT, IVT bridging therapy, or advanced endovascular therapy (with stent retrievers (Mordasini et al, ) or endovascular sonolysis (Kuliha et al, )). A recent meta‐analysis showed that pretreatment with IVT in patients with large vessel occlusions only resulted in a successful recanalization rate of approximately 10%, with patients requiring additional endovascular therapy (Tsivgoulis, Geisler, et al, ; Tsivgoulis, Katsanos, et al, ).…”

Section: Discussionmentioning

confidence: 99%

“…The advanced endovascular therapy with the highest rate of recanalization is the most likely to become the best treatment for PCS, according to the similar history of reperfusion therapy for acute myocardial infarction (Widimsky, Coram, & Abou‐Chebl, ) and for ACS (Sardar et al, ; Tsivgoulis, Geisler, et al, ; Tsivgoulis, Katsanos, et al, ). Inspired by the rapid progress being made in endovascular therapy techniques, the overall recanalization rate of BAO patients using novel stent retrievers (Mordasini et al, ) or endovascular sonolysis (Kuliha et al, ) could reach as high as 100%, and the rate of ICH has been relatively low, which demonstrates the greatly improved benefits and reduced complications of endovascular therapy. However, it is still worth mentioning that a streamlined organization with reduced time delays in stroke care plays a key role in delivering the benefits of reperfusion therapies for both PCS and ACS patients.…”

Section: Discussionmentioning

confidence: 99%

“…Inspired by the rapid progress being made in endovascular therapy techniques, the overall recanalization rate of BAO patients using novel stent retrievers (Mordasini et al, 2013) or endovascular sonolysis (Kuliha et al, 2013) could reach as high as 100%, and the rate of ICH has been relatively low, which demonstrates the greatly improved benefits and reduced complications of endovascular therapy.…”

Section: Patientsmentioning

confidence: 99%

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Effects of time delays on the therapeutic outcomes of intravenous thrombolysis for acute ischemic stroke in the posterior circulation: An observational study

Huang

Song

et al. 2019

Brain and Behavior

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Objectives We aim to demonstrate the effects of time delays on the therapeutic outcomes of intravenous thrombolysis (IVT) in acute posterior circulation stroke (PCS) patients. Methods Consecutive PCS cases treated with IVT alone were retrospectively examined. The primary end point was set to be a favorable outcome (modified Rankin Scale [mRS] ≤2) at 3 months, and angiographic recanalization was set to be the secondary outcome. Results A total of 95 PCS cases with IVT were recruited. The patients with favorable outcomes and those without favorable outcomes had similar baseline characteristics, except for significantly lower National Institute of Health Stroke Scale (NIHSS) scores (5 vs. 12, respectively; p < 0.001) and less hyperdense basilar artery signs in head CTs (26.5% vs. 70.4%, respectively; p < 0.001) for those with favorable outcomes. For patients with an onset‐to‐treatment time (OTT) of 0–90 min ( n = 5), 91–180 min ( n = 38), 181–270 min ( n = 37), or ≧271 min ( n = 15), the rate of favorable outcome was 100.0%, 71.1%, 67.6%, or 73.3%, respectively, and the Cochran–Armitage trend test showed no linear trend between the OTT and the clinical prognosis of IVT in PCS ( p = 0.501) patients. In addition, the rates of recanalization were 100.0%, 68.4%, 64.9%, and 46.7%, and the Cochran–Armitage trend test suggested a linear trend between the OTT and recanalization ( p = 0.046); that is, the proportion of PCS patients who underwent recanalization decreased with increasing OTTs. In the multivariate logistic regression analysis, after adjusting for confounding factors with p ≦ 0.20 in the univariate analysis, baseline NIHSS scores and hyperdense basilar artery signs were negatively associated with favorable outcomes, with odds ratios (OR) of 0.884 (95% confidence interval [CI], 0.804–0.971; p = 0.010) and 0.208 (95% CI, 0.062–0.693; p = 0.011), respectively. In addition, there was a negative association between recanalization, OTTs (OR, 0.993, 95% CI, 0.987–0.999; p = 0.029), and baseline NIHSS scores (OR, 0.881, 95% CI, 0.802–0.967; p = 0.008). Conclusion Irrespective of stroke severity, the therapeutic effects of recanalization after IVT decreased significantly with longer time delays in PCS patients.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

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Effects of time delays on the therapeutic outcomes of intravenous thrombolysis for acute ischemic stroke in the posterior circulation: An observational study

Huang

Song

et al. 2019

Brain and Behavior

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“…V žádné z těchto studií nebyla mechanická rekanalizace indikována u pa cienta kontraindikovaného k IVT. Z výsledků menších publikovaných studií [17,[24][25][26] však vyplývá, že z léčby mechanickou rekanalizací profitují především pa cienti, u nichž IVT selhala (nedošlo po ní tedy k rekanalizaci tepny), a pa cienti, u kterých je IVT kontraindikována.…”

Section: Diskuzeunclassified

A Registry of Mechanical Recanalization Procedures in Acute Stroke – Pilot Results from a Multicentre Registry

Roubec¹,

Kuliha²,

Školoudík³

2015

Cesk Slov Neurol N

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SHORT COMMUNICATION KRÁTKÉ SDĚLENÍ Registr mechanických rekanalizací u akutního iktu-pilotní výsledky multicentrického registru A Registry of Mechanical Recanalization Procedures in Acute Stroke-Pilot Results from a Multicentre Registry Souhrn Úvod: Nejčastějším podkladem ischemické cévní mozkové příhody (iCMP) je akutní okluze mozkové tepny. Časná rekanalizace je spojena se signifi kantně vyšší šancí na dosažení soběstačnosti pa cienta a snížením mortality. V posledních letech se k farmakologické léčbě připojily mechanické (neurointervenční) metody. Cílem registru je zmapovat dostupnost a sledovat bezpečnost a úspěšnost mechanických rekanalizačních metod v běžné klinické praxi. Metodika: Do registru jsou zadáváni konsekutivně všichni pa cienti s akutní iCMP a léčení metodou mechanické rekanalizace v zúčastněných komplexních cerebrovaskulárních a iktových centrech v České republice. Po prvním zpracování údajů jsou prezentována demografi cká data, tíže iktu, úspěšnost rekanalizace, výsledný klinický stav pa cientů a frekvence symp tomatického intrakraniálního krvácení (SICH). Výsledky: Do multicentrického registru bylo od 1. 1. 2006 do 21. 9. 2014 zařazeno celkem 353 pa cientů (210 mužů, průměrný věk 66,0 ± 13,1 let) s akutní iCMP a okluzí krční nebo mozkové tepny, kteří byli léčeni endovaskulárně. Medián vstupního NIHSS skóre byl 16 bodů. Rekanalizace tepny (TICI 2b-3) bylo dosaženo v 58,6 % a soběstačnosti po třech měsících (modifi kovaná Rankinova škála, mRS 0-2) u 45,3 % pa cientů. SICH se vyskytlo u 4,2 % pa cientů a tříměsíční mortalita v celém souboru činila 26,1 %. Závěr: V České republice v současnosti funguje systém organizace péče o pa cienty s iCMP na vysoké úrovni s dostupností nejen systémové trombolýzy, ale také metod mechanické rekanalizace. Prováděné endovaskulární výkony se jeví jako bezpečné s vysokou úspěšností rekanalizace tepny.

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“…Kuliha et al compared 7 BAO patients undergoing EkoSonic endovascular sonolysis with controls showing significant reduction in mortality rate (0 vs. 66.7% of patients, P=0.013) (ref. 53 ). The efficacy in BAO still remains to be clarified and comparison with other endovascular techniques is also needed.…”

Section: Endovascular Sonolysismentioning

confidence: 99%

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

Dorňák

Herzig²,

Šaňák³

et al. 2014

BIOMED PAP

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Background. Acute basilar artery occlusion (BAO) is relatively infrequent form of acute ischemic stroke associated with severe and persisting neurological deficit and high mortality rate (to 86%). Early recanalization is essential for good clinical outcome but the most effective treatment approach remains unestablished. Several treatment strategies are currently available but their safety and efficacy have only been tested in retrospective/prospective case series. Randomized controlled trials (RCTs) are lacking. Methods and Results. We searched the PubMed database for assessments of recanalization rate and clinical outcome in BAO patients treated with various treatment methods. The results show that antithrombotics are least effective while specific reperfusion therapies including intravenous thrombolysis (IVT) and various types of intra-arterial therapy (IAT) are more so. Less than half of BAO patients reach independent outcome following IVT with a recanalization rate 52 -78%. Even though IAT recanalizes BAO more frequently (in up to 100%), the higher recanalization rate is not necessarily associated with better outcome. Conclusions. Good clinical outcome is strongly dependent on recanalization time. Thus, the concept of bridging therapy, combining widely available IVT with IAT, was introduced and is usually considered a rescue strategy in nonresponders to IV alteplase. A trend to better outcome in patients treated with bridging therapy in some studies, has to be confirmed by large RCTs.

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Safety and Efficacy of Endovascular Sonolysis Using the EkoSonic Endovascular System in Patients with Acute Stroke

Abstract: BACKGROUND AND PURPOSE:Sonolysis is a new therapeutic procedure for arterial recanalization. The aim of this study was to confirm the safety and efficacy of endovascular sonolysis by using the EkoSonic Endovascular System in subjects with acute ischemic stroke.

Cited by 10 publications

References 45 publications

Effects of time delays on the therapeutic outcomes of intravenous thrombolysis for acute ischemic stroke in the posterior circulation: An observational study

Effects of time delays on the therapeutic outcomes of intravenous thrombolysis for acute ischemic stroke in the posterior circulation: An observational study

A Registry of Mechanical Recanalization Procedures in Acute Stroke – Pilot Results from a Multicentre Registry

Management of acute basilar artery occlusion: Should any treatment strategy prevail?

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