Sonothrombolysis in acute stroke and myocardial infarction: A systematic review

Abstract

a b s t r a c tIntroduction: Current treatment of patients with an acute occlusion of a cranial or a coronary artery, in for example ST segment elevation myocardial infarction (STEMI), consists of either thrombolysis or percutaneous intervention. Various thrombolytic agents (tissue plasminogen activators) are used for reperfusion therapy in patients with STEMI. However, their use may be associated with an increased risk of bleeding which is inherent to their action mechanism. Therefore, new methods of coronary clot resolution are being studied in an attempt to potentiate the efficacy and reduce the side effects of thrombolytics. A new method is ultrasound mediated thrombus dissolution, or sonothrombolysis. The current literature exploring sonothrombolysis is diverse in size and quality. In this systematic review of the current literature, we describe cardiovascular applications of sonothrombolysis in patients. A comparison to the neurovascular application in ischemic stroke is made, as more research has been performed on patients suffering from stroke. Methods: A systematic search was performed following the PRISMA guidelines using EMBASE and MEDLINE databases regarding sonothrombolysis in human ischemic stroke and acute myocardial infarction patients. Results: 12 original case-control or randomized controlled trials using a combination of ultrasound and microbubbles were found. 6 trials studied ischemic stroke, and 6 trials studied acute myocardial infarction. Conclusion: This systematic review provides up to date information on the subject of sonothrombolysis.

No benefit of additional treatment with exenatide in patients with an acute myocardial infarction

“…This is mediated by a multitude of factors that eventually culminate in loss of mitochondrial integrity and hypercontracture, leading to cardiomyocyte death [3]. This phenomenon is called reperfusion injury and contributes for up to 40% to the final myocardial infarct size [4], which is an important determinant of clinical outcome in patients with ST elevated myocardial infarction [5]. Therapies to prevent reperfusion injury are therefore of utmost importance.…”

Sonoreperfusion Therapy Kinetics in Whole Blood Using Ultrasound, Microbubbles and Tissue Plasminogen Activator

“…These processes involving stable and inertial cavitation causes microstreaming, fluid jets and a focal temperature increase resulting in bioeffects (Price et al 1998). Strategies utilizing these potent sources of energy to effectively disrupt thrombi have been mainly focused on recanalyzing large vessels in patients with large thrombi in ischemic stroke and STEMI patients (Roos et al 2014) and is known as sonothrombolysis. Therapy utilizing this lytic effect to restore microvascular perfusion during MVO is called sonoreperfusion (SRP) therapy (Pacella et al 2015).…”

Microbubbles and UltraSound-accelerated Thrombolysis (MUST) for peripheral arterial occlusions: protocol for a phase II single-arm trial

“…A systematic review of sonothrombolysis shows that this treatment option improves short-term and long-term clinical outcomes, while potentially reducing bleeding risk, in patients with ischaemic stroke. 13 Nevertheless, dose escalation studies show that the safety (in terms of bleeding and microemboli) needs to be further investigated before enrolling patients in phase III trials. 14 Few and heterogeneous studies examined the therapeutic application of sonothrombolysis in patients with myocardial infarction.…”