Publications (318) View all
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Article: The Role of Sonolysis and Sonothrombolysis in Acute Ischemic Stroke: A Systematic Review and Meta-analysis of Randomized Controlled Trials and Case-Control Studies.
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ABSTRACT: OBJECTIVES: To assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke. SEARCH METHODS: Electronic databases and grey literature were searched under different MeSH terms from 1970 to present. SELECTION CRITERIA: Randomized control trials (RCTs) and case control studies (CCSs) on sonolysis and sonothrombolysis alone or with microsphere in acute stroke patients (>18 old). Outcome measures included complete recanalization (CR) at 1-2 and 24 hours, 3 months modified Rankin Scale (mRS), and symptomatic intracerebral hemorrhage (sICH). Data was extracted to Review Manager software. RESULTS: Fifty-seven studies were retrieved and analyzed. Ten studies (7 RCTs and 3 CCSs) were included in our meta-analysis, which revealed that sonolysis and sonothrombolysis are safe (OR of sICH: 1.14; 95% confidence interval (CI): 0.56- 2.34;P=0.71) and effective (OR of CR at 1-2 hours: 2.95;95% CI: 1.81-4.81;P<0.00001) and have more than two-fold higher likelihood of favourable long-term outcome (3-month mRS 0-2; OR: 2.20; CI:1.52-3.19;P<0.0001). Further subgroup analysis based on the presence of microsphere revealed that it is safe (OR of sICH: 1.18; CI:0.433.24;P=0.75) and effective (OR of CR: 2.61; CI: 1.36-4.99;P=0.004). Subgroup analysis based on sonolysis revealed to be safe and effective. CONCLUSIONS: This novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.Journal of neuroimaging: official journal of the American Society of Neuroimaging 04/2013; · 1.72 Impact Factor -
Article: Favorable Vascular Profile is an Independent Predictor of Outcome: A Post Hoc Analysis of the Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke Trial.
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ABSTRACT: BACKGROUND AND PURPOSE: We hypothesized that a favorable vascular profile (FVP) defined as anatomic intactness of the Circle of Willis combined with a stable cerebral perfusion pressure (mean arterial blood pressure>65 mm Hg) is a prerequisite for collateral recruitment and maintenance and may improve outcome. We performed post hoc analyses of a subset of the Safety and Efficacy of NeuroFlo Technology in Ischemic Stroke (SENTIS) trial data set to identify whether FVP is associated with independent outcome. METHODS: SENTIS was a randomized, controlled device trial comparing hemodynamic augmentation with the NeuroFlo device to best medical treatment. We identified all patients from the primary dataset (n=515 patients) with available intracranial vascular imaging at baseline. Vascular imaging data were read blind to clinical and treatment data. We performed univariate and multivariate analyses to identify predictors of independent outcome (modified Rankin Scale 0-2) at 90 days. RESULTS: A total of 192/515 SENTIS subjects had available baseline vascular imaging (91 treated/101 controls). Baseline characteristics did not differ between groups. Overall, FVP was seen in 89.6% of patients and predicted independent outcome in univariate (odds ratio, 7.46; 95% confidence interval, 1.68-33.18; P=0.0082) and multiple logistic regression analyses (odds ratio, 10.22; 95% confidence interval, 1.78-58.57; P=0.0091). Aside from FVP, only baseline National Institutes of Health Stroke Scales (NIHSS; odds ratio, 0.74; 95% confidence interval, 0.67-0.82, P<0.0001) entered the predictive model. There was no interaction with randomization to treatment or control. CONCLUSIONS: FVP and baseline NIHSS independently predicted outcome in this subset of the SENTIS population. FVP is a novel parameter to predict outcome of acute stroke patients and further studies will establish its potential role for selection of optimal candidates for hemodynamic augmentation.Clinical Trial Registration Information-URL: http://www.clinicaltrials.gov. Unique identifier: NCT00119717.Stroke 04/2013; · 5.73 Impact Factor -
Article: Comprehensive and rapid assessment of carotid plaques in acute stroke using a new single sweep method for three-dimensional carotid ultrasound.
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ABSTRACT: We describe a 68-year-old man with acute stroke in whom the newly developed single sweep method for three-dimensional (3D) carotid ultrasound provided a rapid and comprehensive assessment of atherosclerotic plaque burden in the internal carotid artery. The two-dimensional duplex carotid scan diagnosed 50-69% stenosis, and with the three-dimensional method, the markedly hypoechogenic plaque (total volume 1.42 mL) was shown to occupy 77% of the total arterial volume (1.84 mL), consistent with severe lesion. The ultrasound findings were confirmed by computed tomographic angiography and subsequent carotid endarterectomy. The new single sweep 3D carotid ultrasound has the potential to become a valuable clinical tool in the assessment of stroke patients.Echocardiography 04/2013; 30(4):414-8. · 1.24 Impact Factor -
Dataset: Thrombolysis with intravenous recombinant tissue
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Article: Complexity in differentiating truncated or matured forms of MMP-2 and MMP-9 by zymography in acute ischemic stroke induced rat brain tissues.
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ABSTRACT: Matrix metalloproteinases (MMPs) play an important role in ischemic stroke pathogenesis. In particular MMPs -2 and -9 which are similar in size in their mature forms and share gelatin as their common substrate. Both the MMPs are upregulated in ischemic stroke and play detrimental role during stroke pathogenesis. Throughout this study we demonstrated that pro-MMP2 and pro-MMP9 from ischemic rat brain tissue homogenate can be detected either by immunoblotting or zymography because of their remarkable size difference (72 versus 95kDa). However, the mature form of MMP-2 and MMP-9 cannot be identified individually with zymography because of their almost identical sizes (66 & 67kDa). Using gelatin zymography of ischemic rat brain tissue homogenate we have detected a 65kDa size of MMP band which is likely to be the heterogeneous band of mature MMP-2 and/or MMP-9. Furthermore, we have also detected respective mature MMPs of 65kDa bands that are generated both from recombinant human MMP-2 and MMP-9. Using pull down assay of rat brain tissue homogenate with gelatin agarose beads, we found increased pro-MMP2 and pro-MMP9 activities along with mature MMPs. However, we could not extrapolate the origin of respective mature MMPs in heterogeneous band. In this study we demonstrate that identification and quantification of mature MMPs-2 and -9 cannot be relied by using zymography alone. Therefore we urgently need a reliable technique to identify and measure the respective MMPs. This is also essential to test new stroke therapies targeted to MMP-2 and MMP-9.Journal of neuroscience methods 03/2013; · 2.30 Impact Factor
