CLOTBUST sonothrombolysis in acute stroke is a new addition in the armamentarium of physicians traeting these particularly challenging patients. It uses the simple premise of continuous transfer of ultrasonic wanes to the site of the clot in the blood vessel, which in a way soften ups the clot, such that intravenously given thrombolytic agents can work more effectively, resulting in better recanalisation rates, hence translating into better patient outcome.

We recently performed it on a patient with 3.5 hours of acute stroke onset, patient presenting with right sided weakness and Wernicke's aphasia, MRI showing acute left MCA territory diffusion restriction. As the DWI volume was not much and ASPECTS score was good, thrombolysis was performed along with continuous transcranial Doppler using a 2MHz probe, for two hours. After about 45 minutes, the patient responded, sat up himself and the weakness improved. Over the next 48 hours he continued to improve and had 4+/5 power with some aphasia; the aphasis improved over next two weeks and the patient is independent for ADL.

The TCD frame with the doppler probe in place

MRI showing diffusion restriction in left MCA territory

The TCD wave at the end of the procedure ( 2 hours)

The patient sat up on his own