Minimally invasive evacuation of spontaneous intracerebral hemorrhage using sonothrombolysis.

Object: Catheter-based evacuation is a novel surgical approach for the treatment of brain hemorrhage. The object of this study was to evaluate the safety and efficacy of ultrasound in combination with recombinant tissue plasminogen activator (rt-PA) delivered through a microcatheter directly into spontaneous intraventricular (IVH) or intracerebral (ICH) hemorrhage in humans.

Methods: Thirty-three patients presenting to the Swedish Medical Center in Seattle, Washington, with ICH and IVH were screened between November 21, 2008, and July 13, 2009, for entry into this study.

Sonothrombolysis: an emerging modality for the treatment of acute ischemic and hemorrhagic stroke.

To date, it is believed that rapid removal of impedances hindering normal blood circulation in the brain would salvage ischemic tissue. Hence, most treatment modalities undergoing clinical evaluation for treatment of stroke are focused on faster recanalization in acute ischemic stroke or faster hematoma mass reduction in hemorrhagic stroke. Therapeutic ultrasound is among the promising emerging modalities being clinically evaluated to meet this purpose.

Potentiating intra-arterial sonothrombolysis for acute ischemic stroke by the addition of the ultrasound contrast agents (Optison™ & SonoVue(®)).

Transcranial ultrasound in combination with intravenously administered ultrasound contrast agents (UCA) in the presence or absence of recombinant tissue plasminogen activator (rt-PA) has been widely evaluated as a new modality for treatment of ischemic stroke. Despite the successful demonstration of accelerated clot lysis there are inherent limitations associated with this modality such as inconsistency in temporal window thickness and/or potential serious cardiopulmonary reactions to intravenous administration of UCA that prevent broad application to ischemic stroke populations. As a complementary modality, we evaluated potential lysis enhancement by intra-arterial ultrasound with concurrent intra-clot delivery of UCA and rt-PA.