Other studies showed the effect of endovascular ultrasound-lysis by EKOS system in patients with deep venous thrombosis of lower extremities and in patients with pulmonary embolism [53], [54], [55] and [56]. Mahon et al. [57] published Topoisomerase inhibitor the first experience with endovascular sono-lysis using the EKOS system in patients with acute IS. They used a combination of IAT using rt-PA with endovascular ultrasound applied continuously for 60 min in 10 patients with MCA occlusion and in 4 patients with BA occlusion. Partial or complete recanalization was detected in 57% patients and there were no adverse effects observed during the

therapy. The authors also performed a prospective mono-centric study aimed to confirm a safety and efficacy of intravascular sono-lysis using EKOS system® with 3F microcatheter EkoSonic and 2.05–2.35 MHz ultrasound frequencies for the recanalization of brain

arteries in acute stroke patients within an 8-h time window. The pilot, prospective, observational, single center study of consecutive patients presenting with acute stroke symptoms and radiologically confirmed MCA or BA occlusion was performed. The entire study was conducted in accordance with the Helsinki Declaration of 1975 (as revised in 1983, 2004 and 2008). It was approved by the Local Ethics Committee of University Hospital Ostrava. All subjects signed informed consent. In case of technical problems with regard to signing, their signature was also verified by an independent witness. Patients with (1) acute IS, (2) Selleckchem Tariquidar NIHSS score of 10–24 points on admission, (3) MCA or BA occlusion detected by computed tomography (CT) angiography and digital

subtraction angiography (DSA) (Fig. 1a and b), (4) admitted and treated within 8 h since stroke onset, and with (5) signed informed Roflumilast consent were consecutively enrolled to the study during 12 months. Exclusion criteria were (1) previous disability, (2) intracranial bleeding or tumor on brain CT, (3) infarction on brain CT in more than 2/3 of the MCA territory, and (4) partial or complete recanalization of brain artery after IVT treatment detected using transcranial duplex sonography. A physical examination, blood samples, electrocardiogram, chest X-ray, and standard neurologic evaluation by a certified neurologist using the NIHSS were performed on admission followed by brain CT and CT angiography (CTA) of cervical and intracranial arteries. Patients underwent standard treatment [58] and [59]. Patients who fulfilled SITS-MOST criteria [60] for IVT were treated using rt-PA intravenously (0.9 mg/kg) within 4.5 h since stroke onset. Secondary preventive therapy was administered according to the European Stroke Organisation guidelines [59]. The interventional procedure started with arterial puncture via femoral approach. At the beginning of the procedure, heparin was administered intraarterially (50 IU/kg). Then, the 6F sheath insertion was performed with standard Seldinger technique.