الفهرس 
Cerebrovascular strokeOnly 14 pages are availabe for public view
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Abstract
Stroke is considered a global burden worldwide and a leading cause of long-term disability (Benjamin, E.J., et al, 2017). Intravenous thrombolysis is the only approved medical treatment for acute ischemic stroke patients with recanalization rates being not satisfactory in many patients that are left with a substantial brain damage, with high rates of disability and mortality (Van der Worp, H.B. and van Gijn, J., 2007). Mechanical thrombectomy is an approved neuro-interventional modality for treating such cases. However, it is not available at all stroke or medical centers with very much higher financial costs (Powers, W.J., et al, 2015). This may pave the way for any adjuvant therapy that augments the thrombolytic therapy or even be used alone whenever other modalities cannot be achieved or contra-indicated and increases the rates of recanalization with further effect on the functional clinical outcome. This study aimed to explore ultrasound enhanced thrombolysis and evaluate its possible role on the arterial recanalization after acute ischemic stroke and its correlation with early functional outcome together with evaluation of its safety. In this prospective randomized controlled monocenter study, 60 patients with acute first-ever ischemic stroke are recruited from the Department of Neuropsychiatry, and Psychiatry and Neurology Center, Tanta University Hospital. They were presented with MCA main stem infarction as evidenced clinically and ascertained by investigational tools as CT brain, MRI brain with diffusion ‘‘when needed’’, and TCCS. Patients with indefinite time of onset of stroke or those with poor acoustic temporal window are excluded together with stroke due to occlusion of intracerebral arteries rather than middle cerebral artery, or branch middle cerebral artery occlusion. Thorough history taking, and general medical and neurological assessment are done for each patient. Early brain CT and/or MRI is done to confirm the diagnosis and assess the degree of MCA stenosis according to Alberta Stroke Program Early CT Score (ASPECTS) (Pexman, J.W., et al, 2001). Routine laboratory investigations are included with management of cerebral ischemic stroke according to the (American Heart Association/ American Stroke Association) AHA/ASA stroke management guidelines (Goldstein, L.B., et al, 2017, Powers, W.J., et al, 2018). Transcranial color-coded sonography (TCCS) was done for evaluation of MCA occlusion for all groups immediately, and after 60 minutes to ascertain occlusion and to evaluate recanalization according to Thrombolysis in Brain Ischemia (TIBI) score (Andrew et al.; 2001). A session of sonothrombolysis was performed using transcranial color-coded duplex sonography (TCCS) and adjusted on 2 MHz frequency continuously for one hour with manually handled probe via trans-temporal approach, horizontal plane. Patients were followed up clinically and radiologically by CT scan done after 24 hours from stroke onset to detect any neurological complication appears during the study like hemorrhagic transformation. Follow up ultrasound was done for all groups after 24 hours from stroke onset to assess recanalization using the same parameters. Patients were followed clinically after one hour, 24 hours and one week to assess the early functional outcome in relation to each intervention.