Sonolysis in Prevention of Brain Infarction During Cardiac Surgery (SONORESCUE)

Abstract

Here, we examined whether intraoperative sonolysis can alter the risk of new ischemic lesions in the insonated brain artery territory during coronary artery bypass grafting (CABG) or valve surgery.Silent brain ischemic lesions could be detected in as many as two-thirds of patients after CABG or valve surgery.Patients indicated for CABG or valve surgery were allocated randomly to sonolysis (60 patients, 37 males; mean age, 65.3 years) of the right middle cerebral artery (MCA) during cardiac surgery and control group (60 patients, 37 males; mean age, 65.3 years). Neurologic examination, cognitive function tests, and brain magnetic resonance imaging (MRI) were conducted before intervention as well as 24 to 72 hours and 30 days after surgery.New ischemic lesions on control diffusion-weighted MRI in the insonated MCA territory ≥0.5 mL were significantly less frequent in the sonolysis group than in the control group (13.3% vs 26.7%, P = 0.109). The sonolysis group exhibited significantly reduced median volume of new brain ischemic lesions (P = 0.026). Stenosis of the internal carotid artery ≥50% and smoking were independent predictors of new brain ischemic lesions ≥0.5 mL (odds ratio = 5.685 [1.272–25.409], P = 0.023 and 4.698 [1.092–20.208], P = 0.038, respectively). Stroke or transient ischemic attack occurred only in 2 control patients (P = 0.496). No significant differences were found in scores for postintervention cognitive tests (P > 0.05).This study provides class-II evidence that sonolysis during CABG or valve surgery reduces the risk of larger, new ischemic lesions in the brain.www.clinicaltrials.gov (NCT01591018).

SONOlysis in prevention of Brain InfaRctions During Internal carotid Endarterectomy (SONOBIRDIE) trial – study protocol for a randomized controlled trial

“…In accordance with previous studies [22, 25–29], a new ischemic brain lesion is defined as hyperintense regions on the post-intervention DWI that were not present on pretreatment images. The volume of new brain infarctions will be measured manually.…”

“…Furthermore, the SONOBUSTER trial has demonstrated the effect of intraoperative sonolysis on the reduction of the prevalence and volume of new brain ischemic lesions after CEA and carotid stenting [22]. Results of the SONORESCUE trial have also demonstrated a significant reduction in the prevalence of larger new ischemic lesions and lesion volume in the brain after cardiac surgery [29]. The possible usability of sonolysis in the prevention of brain lesions during carotid revascularization was highlighted in the recently published review paper “The year in cardiology 2015: peripheral circulation” [30].…”

“…The mechanisms of sonolysis in the present study include acceleration of enzymatic fibrinolysis by the direct activation of a fibrinolytic system and increased transport of fibrinolytic agents (e.g., plasmin) into the thrombus by mechanical disruption of thrombus structure, destruction of gaseous bubbles, and transient peripheral vasodilatation [12–22, 29, 31, 32]. …”

Sonothrombolysis for Ischemic Stroke

“…In view of the risk of new brain ischemic lesions that may occur in up to two-thirds of patients undergoing coronary artery bypass grafting or cardiac valve surgery, Skoloudik et al found in the randomized controlled SONORESCUE trial ( n = 60 vs. 60, mean age 65.3 yr) that intra-operative sonolysis would reduce the risk of new lesions > 0.5 mL as well as the median volume of new ischemic lesions on diffusion-weighted imaging (DWI) MRI in this group of patients [ 95 ]. Clinical stroke or transient ischemic attack (TIA) occurred in 0% of treated vs. 3.3% of untreated patients ( p = 0.496).…”