期刊名称：Aktuelnosti iz Neurologije, Psihijatrije i Graničnih Područja
印刷版ISSN：0354-2726
出版年度：2010
卷号：XVIII
期号：3
页码：33-41
出版社：Clinical Center of Vojvodina
摘要：Intravenous administration of recombinant tissue plasminogen activator remains the fastest and widely feasible strategy to initiate treatment in acute ischemic stroke. Because it works by inducing recanal-ization of an occluded vessel, augmentation of this process is desirable and diagnostic transcranial Doppler ultrasound can accomplish this safely. Ultrasound delivers mechanical pressure waves to the clot, thus ex-posing more thrombus surface to circulating drug. Moreover, intravenous gaseous microspheres with ultra-sound have been shown to be a potential alternative to fi brinolytic agents to recanalize discrete thrombot-ic arterial occlusions. For the fi rst time in clinical medicine, the international multicenter CLOTBUST trial showed that ultrasound enhances the thrombolytic activity. In the CLOTBUST trial, the dramatic clinical recovery from stroke coupled with arterial recanalization (38% vs. 13%). Th e rates of symptomatic intrac-erebral hemorrhage (sICH) were similar in the active and placebo group (4.8% vs. 4.8%). A microsphere dose-escalation study called TUCSON showed sustained complete recanalization rates of 67% in patients receiving TCD monitoring with a 1.4-mL perfl utren-lipid microsphere dose compared with controls receiv-ing rt-PA alone with no increase in hemorrhage rate. Smaller clinical trials using transcranial color coded sonography reported recanalization rates ranging from 27% to 86% and sICH rates of 0–18%. In this ar-ticle, we review the current applications of ultrasound and microspheres in stroke management including augmentation of systemic thrombolysis.
