Contrast‐enhanced sonothrombolysis in acute ischemic stroke patients without intracranial large‐vessel occlusion
Sonothrombolysis disaggregates fibrin fibers, promote microstreaming, and increase the thrombolytic effect of tissue plasminogen activator (tPA).7 Studies have shown that sonothrombolysis leads to a more efficient large‐vessel recanalization than treatment with iv thrombolysis alone.9 The effect of sonothrombolysis may be further augmented through the addition of intravenous gas‐filled contrast agents originally developed for diagnostic purposes. These microbubbles increase thrombus dissolution through stable cavitation and mechanical stress.7 Treatment of acute ischemic stroke with sonothrombolysis in combination with microbubbles, that is, contrast‐enhanced sonothrombolysis (CEST), has been associated with improved rates of recanalization in patients with LVO.12 Animal studies have also shown promising results with CEST in rats with impaired microperfusion following recanalization of LVO, suggesting a beneficial effect of CEST on the ischemic microcirculation.14 The exact mechanisms behind this effect are not known. No studies have so far investigated the treatment effect of CEST in acute ischemic stroke without LVO.
NOR‐SASS was a phase III trial of CEST in a general stroke population.15 In this study, we aimed to assess safety and efficacy of CEST in acute ischemic stroke patients without LVO on admission.