• Maher Saqqur, Georgios Tsivgoulis, Francois Nicoli, David Skoloudik, Vijay K Sharma, Vincent Larrue, Jürgen Eggers, Fabienne Perren, Paris Charalampidis, Dale Storie, Ashfaq Shuaib, and Andrei V Alexandrov.
• From the Department of Medicine (Neurology), University of Alberta, Edmonton, Alberta, Canada.
• J Neuroimaging. 2014 May 1;24(3):209-20.

ObjectivesTo assess the evidence on the safety and efficacy of sonothrombolysis in acute stroke.Search MethodsElectronic databases and grey literature were searched under different MeSH terms from 1970 to present.Selection CriteriaRandomized 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.ResultsFifty-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.ConclusionsThis novel treatment appears safe and effective. The evidence of microsphere as an enhancement of sonothrombolysis is evolving.Copyright © 2013 by the American Society of Neuroimaging.

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