EkoSonic SV^TM System for Interventional Therapy in Ischemic Stroke Patients

Czech version

Authors: T. Jonszta ¹; D. Czerný ¹; J. Krajča ¹; M. Kuliha ²; M. Roubec ²; D. Školoudík ²; V. Procházka ¹
Authors‘ workplace: Oddělení intervenční radiologie a angiologie, FN Ostrava ¹; Neurologická klinika LF OU a FN Ostrava ²
Published in: Cesk Slov Neurol N 2013; 76/109(3): 329-335
Category: Original Paper

Overview

Objective:
We evaluate retrospective data of eleven consecutive patients treated with targeted intra- arterial rt- PA administration with simultaneous endovascular ultrasound insonation with EkoSonic SV^TM catheter.

Material and methods:
Eleven patients with medial cerebral artery or basilar artery occlusion were treated, 7 men, 4 women, average age 65.1 years. EkoSonic SV^TM catheter was used for medial cerebral artery and basilar artery occlusion treatment.

Results:
We were unable to navigate the catheter to the occlusion site in one patient, the vessel was recanalized by mechanical thrombus extraction and stent implantation. Artery recanalization was achieved in nine out of ten patients in whom the insonation was performed. Complete recanalization after insonation with EkoSonic^TM system was noted in four patients, prior interventions on the proximal access arteries were performed in two of these patients. The result after insonation was suboptimal in three patients (TICI 1– 2) and, therefore, a different type of mechanical recanalization was used in two patients and IIb/ IIIa blocator was administered in one patient. After insonation, vessel reopening was not achieved in three patients – the artery was recanalized by direct stent placement in two of them and the procedure was terminated in one. Haemorrhagic complications were not detected in any patient.

Conclusion:
Favourable results for artery recanalization rate were achieved, no adverse events nor complications were detected. The EkoSonic SV^TM intra‑ arterial thrombolytic system represents a very promising alternative to other mechanical methods of intracranial artery recanalization in patients with acute ischemic stroke.

Key words:
stroke – intra-arterial thrombolysis – endovascular techniques – EkoSonic SV^TM catheter

Sources

1. Bruthans J. Epidemiologie cévních mozkových příhod. Kapitoly z kardiologie 2010; 8(4): 133– 137.

2. Kalita Z et al. Akutní cévní mozkové příhody: diagnostika, patofyziologie, management. Praha: Maxdorf 2006.

3. Nogueira RG, Schwamm LH, Hirsch JA. Endovascular approaches to acute stroke, part 1: drugs, devices, and data. AJNR Am J Neuroradiol 2009; 30(4): 649– 661.

4. Mahon BR, Nesbit GM, Barnwell SL, Clark W, Marotta TR, Weill A et al. North American clinical experience with the EKOS MicroLysUS infusion catheter for the treatment of embolic stroke. AJNR Am J Neuroradiol 2003; 24(3): 534– 538.

5. Higashida RT, Furlan AJ, Roberts H, Tomsick T,Connors B, Barr J et al. Trial design and reporting standards for intra- arterial cerebral thrombolysis for acute ischemic stroke. Stroke 2003; 34(8): e109– e137.

6. EKOS. Ultrasound accelerated thrombolysis – an overview. Available from: http:/ / www.ekoscorp.com/ healthcare_professionals.htm.

7. Meyers PM, Schumacher HC, Higashida RT, Barnwell SL, Creager MA, Gupta R et al. Indications for the performance of intracranial endovascular neurointerventional procedures: a scientific statement from the American Heart Association Council on Cardiovascular Radiology and Intervention, Stroke Council, Council on Cardiovascular Surgery and Anesthesia, Interdisciplinary Council on Peripheral Vascular Disease and Interdisciplinary Council on Quality of Care and Outcomes Research. Circulation 2009; 119(16): 2235– 2249.

8. Tomsick T, Broderick J, Carrozella J, Khatri P, Hill M,Palesch Y et al. Interventional Management of Stroke II Investigators. Revascularization results in the Interventional Management of Stroke II trial. AJNR Am J Neuroradiol 2008; 29(3): 582– 587.

9. Janjua N, Alkawi A, Suri MF, Qureshi AI. Impact of arterial reocclusion and distal fragmentation during thrombolysis among patients with acute ischemic stroke. AJNR Am J Neuroradiol 2008; 29(2): 253– 258.

10. Levy EI, Siddiqui AH, Crumlish A, Snyder KV, Hauck EF, Fiorella DJ et al. First Food and Drug Administration‑ approved study prospective trial of primary intracranial stenting for acute stroke: SARIS (stent‑ assisted recanalization in acute ischemic stroke). Stroke 2009; 40(11): 3552– 3556.

11. Parikh S, Motarjeme A, McNamara T, Raabe R, Hagspiel K, Benenati JF et al. Ultrasound- accelerated thrombolysis for the treatment of deep vein thrombosis: initial clinical experience. J Vasc Interv Radiol 2008; 19(4): 521– 528.

12. Soltani A, Singhal R, Garcia JL, Raju NR. Absence of biological damage from prolonged exposure to intravascular ultrasound: a swine model. Ultrasonics 2007; 46(1): 60– 67.

13. Smith WS, Sung G, Starkman S, Saver JL, Kidwell CS, Gobin YP et al. MERCI Trial Investigators. Safety and efficacy of mechanical embolectomy in acute ischemic stroke: results of the MERCI trial. Stroke 2005; 36(7): 1432– 1438.

14. Nogueira RG, Yoo AJ, Buonanno FS, Hirsch JA. Endovascular approaches to acute stroke, part 2: a comprehensive review of studies and trials. AJNR Am J Neuroradiol 2009; 30(4): 649– 661.

15. Schrijver A, Vos J, Hoksbergen AW, Fioole B, Fritschy W, Hulsebos R et al. Ultrasound- accelerated thrombolysis for lower extremity ischemia: multicenter experience and literature review. J Cardiovasc Surg (Torino) 2011; 52(4): 467– 476.

16. Grommes J, Strijkers R, Greiner A, Mahnken AH, Wittens CH. Safety and feasibility of ultrasound‑ accelerated catheter- directed thrombolysis in deep vein thrombosis. Eur J Vasc Endovasc Surg 2011; 41(4): 526– 532.

17. Shah KJ, Scileppi RM, Franz RW. Treatment of pulmonary embolism using ultrasound- accelerated thrombolysis directly into pulmonary arteries. Vasc Endovascular Surg 2011; 45(6): 541– 548.