Microbubble-Mediated Sonothrombolysis Improves Outcome After Thrombotic Microembolism-Induced Acute Ischemic Stroke Basic Sciences

Background and Purpose— Microthrombi originating from disintegrated clots or formed in situ may account for the poor clinical improvement of acute ischemic stroke after recanalization therapy. We attempted to determine whether microbubble-mediated sonothrombolysis could dissolve platelet-rich and erythrocyte-rich microthrombi, thereby reducing their brain injury-causing potential. Methods— Platelet- and erythrocyte-rich microthrombosis were induced by periadventitial application of 5% ferric chloride or thrombin to mesenteric microvessels in 75 Sprague–Dawley rats. Acute ischemic stroke was induced by intracarotid injection of platelet- or erythrocyte-rich microthrombi in another 50 rats. Rats were randomly divided into control (CON), ultrasound (US), ultrasound and microbubble (US+MB), recombinant tissue-type plasminogen activator (r-tPA), and US+MB+r-tPA groups. The post-treatment mesenteric microvessel recanalization rates, cerebral infarct volumes, and neurological scores were determined. Results— The recanalization rates of platelet- and erythrocyte-rich microthrombi in mesenteric microvessels were higher (P
Source: Stroke - Category: Neurology Authors: Tags: Cerebrovascular Disease/Stroke, Ischemic Stroke, Embolism, Thrombosis Basic Sciences Source Type: research

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We report the results of transcranial ultrasound monitoring in three patients with intracranial arterial stenosis of the middle cerebral artery treated with the only drug-eluting balloon certificated for intracranial use in highly symptomatic intracranial arterial stenosis, ELUTAX "3" (AR Baltic Medical). We performed transcranial Doppler ultrasounds 24 h, 72 h, 10 days, 15 days and 30 days after the angioplasty, thereby measuring mean flow velocity (MFV) in the maximum stenosis area in patients with symptomatic steno-occlusive disease of the middle cerebral artery treated with ELUTAX "3". Two patients ...
Source: Interventional Neuroradiology - Category: Radiology Tags: Interv Neuroradiol Source Type: research
Coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory distress syndrome coronavirus 2. This syndrome generally begins with respiratory symptoms that may progress to single-organ dysfunction (ie, respiratory failure) and then to multiorgan failure and death. In nonpregnant patients admitted to the intensive care unit with COVID-19 pneumonia, the frequency of venous thromboembolic disorders is 25% (20 of 81) detected by ultrasound examination of the lower extremities.1 In another series of 184 patients with confirmed COVID-19 pneumonia, 31% of patients had venous or arterial thromboembolism (defined as ac...
Source: American Journal of Obstetrics and Gynecology - Category: OBGYN Authors: Tags: Letter to the Editors Source Type: research
Conclusion: To our knowledge, this is the first report in which an immediate thrombus formation on the carotid web was observed in a patient with congenital protein C deficiency. In a case of acute ischemic stroke with carotid web, especially when congenital coagulopathy such as protein C deficiency is suspected, careful follow-up with ultrasound imaging should be performed.
Source: Frontiers in Neurology - Category: Neurology Source Type: research
Abstract Fibrinolytic agents including plasmin and plasminogen activators improve outcomes in acute ischemic stroke and thrombosis by recanalizing occluded vessels. In the decades since their introduction into clinical practice, several limitations of have been identified both in terms of efficacy and bleeding risk associated with these agents. Engineered nano- and microparticles address some of these limitations by improving circulation time, reducing inhibition and degradation in circulation, accelerating recanalization, improving targeting to thrombotic occlusions, and reducing off-target effects; however, many...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: J Thromb Haemost Source Type: research
AbstractThis meta-analysis was conducted to assess the safety and efficacy of sonothrombolysis along with intravenous recombinant tissue plasminogen activator, alteplase (IV rtPA), in the management of acute ischemic stroke. Electronic databases were searched under different meSH terms without the restriction of time and language. 1415 studies were analyzed and seven studies that matched the inclusion criteria were selected. Multiple safety and efficacy outcomes were extracted. Our pooled analysis demonstrated that there is no significant difference between sonothrombolysis group and control group in preventing mortality (...
Source: Journal of Thrombosis and Thrombolysis - Category: Hematology Source Type: research
The effect of 220 kHz insonation scheme on rt-PA thrombolytic efficacy in vitro. Phys Med Biol. 2019 Jun 12;: Authors: Kleven RT, Karani KB, Salido NG, Shekhar H, Haworth KJ, Mast TD, Tadesse DG, Holland CK Abstract Ultrasound-enhanced recombinant tissue plasminogen activator (rt-PA) thrombolysis is under development as an adjuvant to ischemic stroke therapy. The goal of this study was to design a pulsed ultrasound (US) exposure scheme that reduced intracranial constructive interference and tissue heating, and maintained thrombolytic efficacy relative to continuous wave (CW) insonation. Three 220-kHz ...
Source: Physics in Medicine and Biology - Category: Physics Authors: Tags: Phys Med Biol Source Type: research
Yolanda Benito1, Pablo Martinez-Legazpi1*, Lorenzo Rossini2, Candelas Pérez del Villar1, Raquel Yotti1, Yolanda Martín Peinador3, Daniel Rodríguez-Pérez4, M. Mar Desco4, Constancio Medrano1, Jose Carlos Antoranz4, Francisco Fernández-Avilés1, Juan C. del Álamo2,5 and Javier Bermejo1 1Department of Cardiology, Hospital General Universitario Gregorio Marañón, Facultad de Medicina, Universidad Complutense de Madrid, Instituto de Investigación Sanitaria Gregorio Marañón and CIBERCV, Madrid, Spain 2Department of Mechanical and Aerospace ...
Source: Frontiers in Physiology - Category: Physiology Source Type: research
Conclusions: Embolism associated with asymptomatic carotid stenosis shows circadian variation with highest rates 4–6 h before midday. This corresponds with peak circadian incidence of stroke and other vascular complications. These and ASED Study results show that monitoring frequency, duration, and time of day are important in ES detection. Introduction Transcranial Doppler (TCD) detected microembolism in the ipsilateral middle cerebral artery (MCA) may help stratify the risk of stroke and other arterial disease complications in persons with advanced (≥60%) asymptomatic carotid stenosis. If so, this techniqu...
Source: Frontiers in Neurology - Category: Neurology Source Type: research
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Source: The Lancet Neurology - Category: Neurology Source Type: research
Abstract INTRODUCTION:  Cerebral micro-embolic signals (MES) predict risk of stroke in carotid stenosis patients. However, MES-negative 'recently symptomatic patients' also have a higher stroke risk than 'asymptomatic patients'. Differences in platelet activation status may contribute to this disparity in risk. METHODS:  This prospective, observational study assessed platelet biomarkers and their relationship with MES in asymptomatic versus symptomatic moderate (≥50-69%) or severe (≥70-99%) carotid stenosis patients. Full blood count parameters were measured and whole-blood flow cytometry was ...
Source: Thrombosis and Haemostasis - Category: Hematology Authors: Tags: Thromb Haemost Source Type: research
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