Pfaffenberger Stefan, Devcic-Kuhar Branka, Kollmann Christian, Kastl Stefan P, Kaun Christoph, Speidl Walter S, Weiss Thomas W, Demyanets Svitlana, Ullrich Robert, Sochor Heinz, Wöber Christian, Zeitlhofer Josef, Huber Kurt, Gröschl Martin, Benes Ewald, Maurer Gerald, Wojta Johann, Gottsauner-Wolf Michael
Department of Internal Medicine II, University of Vienna, Austria.
Stroke. 2005 Jan;36(1):124-8. doi: 10.1161/01.STR.0000150503.10480.a7. Epub 2004 Dec 9.
Recently, 3 clinical trials revealed encouraging results in recanalization and clinical outcome in acute stroke patients when 2-MHz transcranial Doppler monitoring was applied. This study investigated whether a 1.8-MHz commercial diagnostic ultrasound device has the potential to facilitate thrombolysis using an in vitro stroke model.
Duplex-Doppler, continuous wave-Doppler, and pulsed wave (PW)-Doppler were compared on their impact on recombinant tissue plasminogen activator (rtPA)-mediated thrombolysis. Blood clots were transtemporally sonicated in a human stroke model. Furthermore, ultrasound attenuation of 5 temporal bones of different thickness was determined.
In comparison, only PW-Doppler accelerated rtPA-mediated thrombolysis significantly. Without temporal bone, PW-Doppler plus rtPA showed a significant enhancement in relative clot weight loss of 23.7% when compared with clots treated with rtPA only (33.9+/-5.5% versus 27.4+/-5.2%; P<0.0005). Ultrasound attenuation measurements revealed decreases of the output intensity of 86.8% (8.8 dB) up to 99.2% (21.2 dB), depending on temporal bone thickness (1.91 to 5.01 mm).
Without temporal bone, PW-Doppler significantly enhanced thrombolysis. However, because of a high attenuation of ultrasound by temporal bone, no thrombolytic effect was observed in our in vitro model, although Doppler imaging through the same temporal bone was still possible.
最近，3项临床试验显示，在急性卒中患者中应用2兆赫经颅多普勒监测时，在再通和临床结局方面取得了令人鼓舞的结果。本研究调查了一款1.8兆赫的商用诊断超声设备是否有潜力利用体外卒中模型促进溶栓。
比较了双功多普勒、连续波多普勒和脉冲波（PW）多普勒对重组组织型纤溶酶原激活剂（rtPA）介导的溶栓的影响。在人体卒中模型中对血凝块进行经颞骨超声处理。此外，还测定了5块不同厚度颞骨的超声衰减。
相比之下，只有PW多普勒显著加速了rtPA介导的溶栓。在没有颞骨的情况下，与仅用rtPA治疗的血凝块相比，PW多普勒加rtPA显示相对凝块重量损失显著增加23.7%（33.9±5.5%对27.4±5.2%；P<0.0005）。超声衰减测量显示，输出强度下降了86.8%（8.8分贝）至99.2%（21.2分贝），具体取决于颞骨厚度（1.91至5.01毫米）。
在没有颞骨的情况下，PW多普勒显著增强了溶栓效果。然而，由于颞骨对超声的高度衰减，尽管仍可通过同一颞骨进行多普勒成像，但在我们的体外模型中未观察到溶栓效果。
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