Sonothrombolysis in Patients With Acute Ischemic Stroke With Large Vessel Occlusion: An Individual Patient Data Meta-Analysis-Reference-Cited by-同舟云学术

Sonothrombolysis in Patients With Acute Ischemic Stroke With Large Vessel Occlusion: An Individual Patient Data Meta-Analysis

Published:2021-12 Issue:12 Volume:52 Page:3786-3795
ISSN:0039-2499
Container-title:Stroke
language:en
Short-container-title:Stroke

Author:

Tsivgoulis Georgios¹²^ORCID,Katsanos Aristeidis H.³,Eggers Jürgen⁴⁵,Larrue Vincent⁶^ORCID,Thomassen Lars⁷⁸,Grotta James C.⁹,Seitidis Georgios¹⁰^ORCID,Schellinger Peter D.¹¹^ORCID,Mavridis Dimitris¹⁰¹²,Demchuk Andrew¹³¹⁴,Novotny Vojtech⁸,Molina Carlos A.¹⁵,Veroniki Areti Angeliki¹⁶¹⁷^ORCID,Köhrmann Martin¹⁸,Soinne Lauri¹⁹^ORCID,Khanevski Andrej Netland⁸^ORCID,Barreto Andrew D.²⁰,Saqqur Maher²¹²²^ORCID,Psaltopoulou Theodora²³^ORCID,Muir Keith W.²⁴,Fiebach Jochen B.²⁵,Rothlisberger Travis²⁶^ORCID,Kent Thomas A.²⁷²⁸,Mandava Pitchaiah²⁹³⁰,Alexandrov Anne W.¹^ORCID,Alexandrov Andrei V.¹

Affiliation:

1. Department of Neurology, University of Tennessee Health Sciences Center, Memphis (G.T., A.W.A., A.V.A.).

2. Second Department of Neurology, Attikon University Hospital, School of Medicine, National and Kapodistrian University of Athens, Greece (G.T.).

3. Division of Neurology, McMaster University/Population Health Research Institute, Hamilton, Canada (A.H.K.).

4. Department of Neurology, University Hospital Schleswig-Holstein, Campus Lübeck, Germany (J.E.).

5. Department of Neurology, Sana Hospital Lübeck, Germany (J.E.).

6. Department of Neurology, University of Toulouse, Hospital Pierre Paul Riquet, France (V.L.).

7. Department of Neurology, Haukeland University Hospital, Bergen, Norway (L.T.).

8. Institute of Clinical Medicine, University of Bergen, Norway (L.T., V.N., A.N.K.).

9. Clinical Innovation and Research Institute, Memorial Hermann Hospital-Texas Medical Center, Houston (J.C.G.).

10. Department of Primary Education, School of Education, University of Ioannina, Greece (G.S., D.M.).

11. Departments of Neurology and Neurogeriatry, John Wesling Medical Center Minden, Ruhr University Bochum, Germany (P.D.S.).

12. Faculté de Médecine, Université Paris Descartes, France (D.M.).

13. Cumming School of Medicine, University of Calgary, AB, Canada (A.D.).

14. Department of Clinical Neurosciences, Hotchkiss Brain Institute, Calgary, AB, Canada (A.D.).

15. Stroke Unit, Department of Neurology, Vall d’Hebron University Hospital, Barcelona, Spain (C.A.M).

16. Li Ka Shing Knowledge Institute, St. Michael’s Hospital, Unity Health Toronto, Ontario, Canada (A.A.V.).

17. Institute of Reproductive and Developmental Biology, Department of Surgery and Cancer, Faculty of Medicine, Imperial College, London, United Kingdom (A.A.V.).

18. Department of Neurology, University Duisburg-Essen, Germany (M.K.).

19. Department of Neurology, Helsinki University Hospital and Clinical Neurosciences, Neurology, University of Helsinki Finland (L.S.).

20. Department of Neurology, University of Texas Health Science Center at Houston (A.D.B.).

21. Department of Medicine (Neurology), University of Alberta, Edmonton, Canada (M.S.).

22. Neuroscience Institute, Hamad Medical Corporation, Doha, Qatar (M.S.).

23. Department of Hygiene, Epidemiology and Medical Statistics, Medical School, National and Kapodistrian University of Athens, Greece (T.P.).

24. Institute of Neuroscience and Psychology, University of Glasgow, Queen Elizabeth University Hospital, United Kingdom (K.W.M.).

25. Center for Stroke Research Berlin, Charité-University Medicine Berlin, Germany (J.B.F.).

26. Cerevast Medical, Inc, Bothell, WA (T.R.).

27. Texas A&M Health Science Center-Houston campus, University of Texas (T.A.K.).

28. Department of Neurology, Houston Methodist Hospital, TX (T.A.K.).

29. Michael E. DeBakey VA Medical Center, Houston, TX (P.M.).

30. Department of Neurology, Baylor College of Medicine, Houston, TX (P.M.).

Abstract

Background and Purpose: Evidence about the utility of ultrasound-enhanced thrombolysis (sonothrombolysis) in patients with acute ischemic stroke (AIS) is conflicting. We aimed to evaluate the safety and efficacy of sonothrombolysis in patients with AIS with large vessel occlusion, by analyzing individual patient data of available randomized-controlled clinical trials. Methods: We included all available randomized-controlled clinical trials comparing sonothrombolysis with or without addition of microspheres (treatment group) to intravenous thrombolysis alone (control group) in patients with AIS with large vessel occlusion. The primary outcome measure was the rate of complete recanalization at 1 to 36 hours following intravenous thrombolysis initiation. We present crude odds ratios (ORs) and ORs adjusted for the predefined variables of age, sex, baseline stroke severity, systolic blood pressure, and onset-to-treatment time. Results: We included 7 randomized controlled clinical trials that enrolled 1102 patients with AIS. A total of 138 and 134 confirmed large vessel occlusion patients were randomized to treatment and control groups respectively. Patients randomized to sonothrombolysis had increased odds of complete recanalization compared with patients receiving intravenous thrombolysis alone (40.3% versus 22.4%; OR, 2.17 [95% CI, 1.03–4.54]; adjusted OR, 2.33 [95% CI, 1.02–5.34]). The likelihood of symptomatic intracranial hemorrhage was not significantly different between the 2 groups (7.3% versus 3.7%; OR, 2.03 [95% CI, 0.68–6.11]; adjusted OR, 2.55 [95% CI, 0.76–8.52]). No differences in the likelihood of asymptomatic intracranial hemorrhage, 3-month favorable functional and 3-month functional independence were documented. Conclusions: Sonothrombolysis was associated with a nearly 2-fold increase in the odds of complete recanalization compared with intravenous thrombolysis alone in patients with AIS with large vessel occlusions. Further study of the safety and efficacy of sonothrombolysis is warranted.

Publisher

Ovid Technologies (Wolters Kluwer Health)

Subject

Advanced and Specialized Nursing,Cardiology and Cardiovascular Medicine,Neurology (clinical)

Link

https://www.ahajournals.org/doi/pdf/10.1161/STROKEAHA.120.030960

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