Sonothrombolyse mit transkraniellem Ultraschall

Zusammenfassung

Die Sonothrombolyse stellet eine neuartige Therapie zur Rekanalisation eines akuten intrakraniellen Gefäßverschlusses. Für die Anwendung mit transkraniellem „diagnostischem“ Ultraschall konnte in zwei randomisierten Studien in Kombination mit der intravenösen Standardthrombolyse mit rekombinantem Gewebsplasminogenaktivator (recombined tissue-type plasminogen activator, rt-PA) eine signifikant verbesserte Rekanalisation gezeigt werden. Zusätzlich fand sich eine deutliche Tendenz zu einem verbesserten funktionellen Ergebnis nach drei Monaten. Ergebnisse mit begrenzter Fallzahl beim A.-cerebri-media-Hauptstammverschluss lassen die Methode als eine mögliche Alternative zur interventionellen Therapie erscheinen. Unter Verwendung der transkraniellen Duplexsonografie fanden sich Hinweise für eine möglicherweise erhöhte Hirninfarkteinblutungsrate, die sich jedoch nicht bestätigten. Bei Fehlen anderer Therapiemöglichkeiten, z. B. bei Kontraindikation für eine medikamentöse Thrombolyse oder Thrombusextraktion, stellt die Sonothrombolyse allein, also ohne rt-PA, eine alternative Behandlungsoption dar.

Summary

Sonothrombolysis is a novel therapy for recanalization of acute intracranial vessel occlusion. For combining transcranial "diagnostic" ultrasound with recombined tissue-type plasminogen activator (rt-PA), two randomized trials demonstrated the effectiveness for improving recanalization. In addition, a clear tendency was found to an improved functional outcome at three months. Results with limited sample size in middle cerebral artery main stem occlusion offer the method as a possible alternative to interventional therapy. Hints for an increased rate of symptomatic hemorrhagic transformation of brain infarction after sonothrombolysis with diagnostic ultrasound were not confirmed. In the absence of other therapies, for example in case of contraindication to thrombolytic drug or thrombus extraction, sonothrombolysis alone should be considered as an alternative treatment option.

Schlüsselwörter

Akuter ischämischer Schlaganfall - Therapie - transkranieller Ultraschall - Thrombolyse

Keywords

Acute ischemic stroke - therapy - transcranial ultrasound - thrombolysis

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