Sonothrombolysis in acute stroke and myocardial infarction: A systematic review

• This systematic review provides latest insights on clinical use of sonothrombolysis.
• The mechanism is based on cavitation using ultrasound and ultrasound contrast agents.
• Trials in stroke patients are in an advanced stage.
• Myocardial infarction trials are currently gaining momentum.
• Sonothrombolysis is an effective and safe method of treatment in human patients.

IntroductionCurrent 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.MethodsA systematic search was performed following the PRISMA guidelines using EMBASE and MEDLINE databases regarding sonothrombolysis in human ischemic stroke and acute myocardial infarction patients.Results12 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.ConclusionThis systematic review provides up to date information on the subject of sonothrombolysis.

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