A note on Ultrasound Enhanced Thrombolysis in CVA 

Though literature is still young but it shows that ultrasound energy may have a biologic effect that may facilitates the activity of intravenous tPA in ischemic stroke. It is provided via high-frequency transcranial Doppler (TCD). This combination can be further enhanced by the administration of microbubbles (air or gas) which is used as ultrasound contrast agents. While applying this technique, it should be kept in mind that there is some evidence that combination of ultrasound and tPA in ischemic stroke may increase the risk cerebral hemorrhage.


References:

 1. Alexandrov AV, Molina CA, Grotta JC, et al. Ultrasound-enhanced systemic thrombolysis for acute ischemic stroke. N Engl J Med 2004; 351:2170.

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

3. Nacu A, Kvistad CE, Naess H, et al. NOR-SASS (Norwegian Sonothrombolysis in Acute Stroke Study): Randomized Controlled Contrast-Enhanced Sonothrombolysis in an Unselected Acute Ischemic Stroke Population. Stroke 2017; 48:335. 

4. Dinia L, Rubiera M, Ribo M, et al. Reperfusion after stroke sonothrombolysis with microbubbles may predict intracranial bleeding. Neurology 2009; 73:775. Tsivgoulis G, Alexandrov A. Ultrasound-enhanced thrombolysis: from bedside to bench. Stroke 2008; 39:1404.