Martin Kuliha1,2, Martin Roubec1, Eva Hurtíková1, Andrea Goldírová1,3, Roman Herzig4, Václav Procházka5, Tomáš Jonszta5, Jan Krajča5, Dan Czerný5, Tomáš Hrbáč6, David Otáhal6, Daniel Šaňák7, Michal Král7, Kateřina Langová8, David Školoudík1,2,3
Induction: Sonolysis is a new therapeutic option for the acceleration of arterial recanalization. The aim of this study was to confirm a risk reduction of brain infarction during carotid endarterectomy (CEA) and stenting (CAS) using sonolysis with continuous transcranial Doppler (TCD) monitoring by diagnostic 2 MHz probe. Methods: All consecutive patients with internal carotid artery ICA stenosis > 70 %, indicated to CEA or CAS and with signed informed consent, were enrolled to the prospective study during 24 months. Patients were randomized into 2 groups: Group 1 with sonolysis during intervention and Group 2 without sonolysis. Neurological examination, assessment of cognitive functions and brain magnetic resonance imaging (MRI) were performed before and 24 hours after intervention in all patients. Occurrence of new brain infarctions (including infarctions > 0.5 cm3), and the results of Mini-Mental State Examination, Clock Drawing and Verbal Fluency tests were statistically evaluated. Results: Totally 127 patients (87 males, mean age 65.6 ± 7.7 years) were included into the study. Out of the 62 patients randomized to sonolysis group (Group 1), 33 underwent CEA (Group 1a) and 29 CAS (Group 1b). Out of the 65 patients randomized to control group (Group 2), 30 underwent CEA (Group 2a) and 35 CAS (Group 2b). New ischemic brain infarctions on follow up MRI were found in 19 (30.6 %) patients in Group 1; 6 (18.2 %) patients in Group 1a and 13 (44.8 %) in Group 1b. In Group 2, new ischemic brain infarctions were found in 26 (40.0 %) patients; 8 (26.7 %) in Group 2a and 18 (51.4 %) in Group 2b (p > 0.05 in all cases). New ischemic brain infarctions > 0.5 cm3 were found in 5 (8.1 %) patients in Group 1 and in 12 (18.5 %) patients in Group 2 (p = 0.046). No significant differences were found in cognitive tests results between groups (p > 0.05 in all tests). Conclusion: Patients with sonolysis during CEA and CAS had significantly lower risk of new ischemic lesions on MR after intervention in comparison with control group. Sonolysis seems to be effective in the prevention of large ischemic brain infarctions during CEA and CAS.