BACKGROUND Accumulating clinical evidence has indicated that sonothrombolysis can aid in the treatment of ischemic stroke; however, these findings remain controversial. The purpose of the present meta-analysis was to assess randomized clinical studies concerning the effects of sonothrombolysis on ischemic stroke to evaluate its safety and efficacy. METHODS We systematically searched the Cochrane Library, PubMed, and EMBASE databases for literature published between the inception of electronic data and May 2019 regarding sonothrombolysis for acute ischemic stroke. Only randomized controlled trials were included. Data extraction was based on patient characteristics, ultrasound variables (any duration or frequency, without microbubble), and outcome variables (safety and efficacy). RESULTS Five trials were included in the present study. Clinical functional recovery was evaluated at different time points (several days or 3 months), and heterogeneity was low. Sonothrombolysis did not lead to an increase in symptomatic intracranial hemorrhagic complications or death. Our results demonstrated that patients treated with sonothrombolysis had significantly higher rates of recanalization and asymptomatic intracerebral hemorrhage than patients treated with intravenous thrombolysis alone. In the subgroup of middle cerebral artery (MCA) occlusion patients, sonothrombolysis was found to greatly increase the efficacy outcomes compared to intravenous thrombolysis. CONCLUSIONS Evidence suggests that sonothrombolysis is a technically feasible and potentially effective treatment that has beneficial effects on recanalization and increases the rate of asymptomatic intracerebral hemorrhage in stroke patients. Additionally, short- and long-term clinical outcome analyses were improved in the MCA occlusion sonothrombolysis subgroup. Larger clinical trials of MCA occlusion patients are necessary to verify these findings.

中文翻译：

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急性缺血性卒中患者超声溶栓的有效性和安全性：系统评价和荟萃分析

背景越来越多的临床证据表明，超声溶栓可以帮助治疗缺血性中风。然而，这些发现仍然存在争议。本荟萃分析的目的是评估有关超声溶栓对缺血性卒中影响的随机临床研究，以评估其安全性和有效性。方法 我们系统地搜索了 Cochrane 图书馆、PubMed 和 EMBASE 数据库，以查找从电子数据开始到 2019 年 5 月期间发表的关于急性缺血性卒中超声溶栓的文献。仅纳入随机对照试验。数据提取基于患者特征、超声变量（任何持续时间或频率，无微泡）和结果变量（安全性和有效性）。结果 本研究包括五项试验。在不同时间点（数天或3个月）评估临床功能恢复情况，异质性较低。超声溶栓并未导致有症状的颅内出血并发症或死亡增加。我们的结果表明，与单纯静脉溶栓治疗的患者相比，接受超声溶栓治疗的患者的再通率和无症状脑出血的发生率明显更高。在大脑中动脉 (MCA) 闭塞患者亚组中，发现与静脉溶栓相比，超声溶栓可大大提高疗效结果。结论 有证据表明，超声溶栓是一种技术上可行且可能有效的治疗方法，它对脑血管再通具有有益影响，并增加了卒中患者无症状脑出血的发生率。此外，MCA 闭塞声血栓溶解亚组的短期和长期临床结果分析得到改善。需要对 MCA 闭塞患者进行更大规模的临床试验来验证这些发现。