الفهرس 
Acute Ischemic StrokeOnly 14 pages are availabe for public view
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Abstract
Stroke is one of the most common causes of disability and mortality worldwide. It constitutes a burden on health and economy in many countries.
Most patients presenting with an acute ischemic stroke have arterial thrombi occluding extracranial and/or intracranial arteries. Intravenously administered tissue plasminogen activator (TPA) induces thrombolysis and remains the only FDA-approved thrombolytic agent for use in ischemic stroke within 4.5 h from symptom onset.Fast dissolution of the thrombi, and arterial recanalization in acute stroke, often leads to dramatic clinical recovery
Over the past 30 years, in vitro and animal studies have providedevidence that thrombolysis with tPA can be enhanced with ultrasound.Although the mechanisms are still not fully understood, it isknown that ultrasound accelerates enzymatic fibrinolysis primarilythrough non thermal mechanisms by increasing transport of drugmolecules into the clot. Mechanical effects of ultrasoundradiation forces have the ability to influence drug transport.In addition, ultrasound can promote the motion of fluid throughand around the thrombus, an effect called streaming. Ultrasound-enhanced thrombolysis (UET) is a promising new approach to facilitate reperfusion therapies for acute ischemic stroke.
In our study, we were aiming to focus on studying the effect of continuous insonation using transcranial ultrasound on the recanalization rate of acute MCA occlusion and its impact on clinical improvement. Our aim, eventually, was expanded during the study to include predictors that may affect recanalization.
In this study, our patients were randomly assigned into two groups (twenty one patients in each group presented with acute MCA ischemic stroke). MCA was continuously insonated with transcranial Doppler US for one hour in group1 (patients) and it was insonated with conventional diagnostic transcranial Doppler US in group2 (controls). In both groups, the MCA was reexamined with the same device at 20, 60 minutes after insonation to detect possible recanalization.
In this research, we have found that that there was a significant change in MFV after insonation for group1 (patients) in comparison to group2 (controls) and a significant rate of recanlization after insonation for the first group in comparison to the second group.
It was also evident that there was a significant clinical improvement in NIHSS in the first group in comparison to the second group at three time points (Before insonation, end of insonation and 24 hours after insonation especially in patients with complete recanalization.
According to our results, there was no significant correlation between different patient charaterestics (Age, sex, AF, presence of ICA stenosis), medical characteristics (blood sugar, lipids) and change of MFV
In conclusion,sonothrombolysis is a modern therapeutic option to improve the treatment of acute ischemic stroke. It is a ssociated with immediate increase of the mean flow velocity of the occluded artery which improves the clinical condition of patients with acute ischemic stroke.