Sonothrombolysis for acute ischaemic stroke

In acute stroke, sonothrombolysis appears to reduce death or dependency at 3 months and increase recanalisation without clear hazard.

Summary

A Cochrane review included 5 studies with a total of 233 subjects with acute stroke. The trials were started within 12 hours of symptom onset and compared sonothrombolysis with transcranial Doppler or colour flow duplex imaging with iv. tissue plasminogen activator (tPA) (4 trials) or conventional treatment (one trial). For the primary outcome (death or dependency at 3 months), 5 studies with a total number of 206 patients were available (4 trials defined independence as a modified Rankin score of 0 to 2 and one used 0 to 1). Patients treated with sonothrombolysis were less likely to be dead or disabled at 3 months (OR 0.50, 95% CI 0.27 to 0.91). For the secondary outcomes, failure to recanalise was lower in the sonothrombolysis group (n=230) (OR 0.28, 95% CI 0.16 to 0.50), no significant difference was found in mortality (n=206) and in cerebral haemorrhage (n=233).

Comment: The quality of the evidence is downgraded by imprecise results (small trials with wide confidence intervals).

Clinical comments

Date of latest search:

Ədəbiyyat

1. Ricci S, Dinia L, Del Sette M et al. Sonothrombolysis for acute ischaemic stroke. Cochrane Database Syst Rev 2012;10:CD008348.