Ultrasound-Assisted Thrombolysis for Stroke Therapy Better Thrombus Break-Up With Bubbles

Background and Purpose-Ultrasound has been shown to increase recombinant tissue plasminogen activator thrombolysis through stable cavitation, or sustained bubble activity, but this mechanism needs further optimization. Use of low-frequency ultrasound in combination with microbubbles stabilized against dissolution, in the form of ultrasound contrast agents, has resulted in greater lytic efficacy in vitro. Summary of Review-This article reviews the motivation for developing ultrasound-enhanced thrombolysis and the existing evidence for its potential as an intervention for ischemic stroke. Stable cavitation is discussed and current in vitro and ex vivo studies of bubble-mediated recombinant tissue plasminogen activator clot lysis are summarized. Conclusions-Ultrasound-driven stable cavitation nucleated by an infusion of an echo contrast agent facilitates recombinant tissue plasminogen activator thrombolysis. Optimization of this gently effervescent phenomenon has the potential to reduce the morbidity and mortality of victims of ischemic stroke. (Stroke. 2010;41[suppl1]:S50-S53.)