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Ultrasound- and Microspheres-Enhanced Thrombolysis for Stroke Treatment: State of the Art

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Abstract

Intravenous administration of recombinant tissue-plasminogen activator (rt-PA) remains the fastest and widely feasible strategy to initiate treatment in acute ischemic stroke. Because it works by inducing recanalization of an occluded vessel, augmentation of this process is desirable and diagnostic transcranial Doppler (TCD) ultrasound can accomplish this safely. A 2-MHz pulsed-wave monitoring can at least double the chance of early complete arterial recanalization at no increase in the risk of symptomatic intracerebral hemorrhage. Gaseous microspheres, initially developed as ultrasound contrast agents, can further increase the effectiveness of rt-PA. A recent microsphere dose-escalation study called TUCSON showed sustained complete recanalization rates of 67% in patients receiving TCD monitoring with a 1.4-mL perflutren-lipid microsphere dose compared with controls receiving rt-PA alone with no increase in hemorrhage rate. In this article, we review the current and emerging applications of ultrasound and microspheres in stroke management including augmentation of systemic thrombolysis and implications for future reperfusion strategies.

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Abbreviations

CLOTBUST:

Combined Lysis of Thrombus in Brain Ischemia Using Transcranial Ultrasound and Systemic TPA

IMS:

Interventional Management of Stroke

TRUMBI:

Transcranial Low-Frequency Ultrasound-Mediated Thrombolysis in Brain Ischemia

TUCSON:

Transcranial Ultrasound in Clinical Sonothrombolysis

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Disclosure

Dr. Andrei Alexandrov has received grant support from the National Institute of Neurological Disorders and Stroke, Genentech Inc., and ImaRx Therapeutics Inc., and serves on the speaker’s bureau of Genentech Inc. No other potential conflicts of interest relevant to this article were reported.

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Authors and Affiliations

  1. Comprehensive Stroke Center, University of Alabama Hospital, RWUH M226 619, 19th Street South Birmingham, AL 3524, Birmingham, AL, 35249-3280, USA

    Clotilde Balucani & Andrei V. Alexandrov

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  1. Clotilde Balucani
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  2. Andrei V. Alexandrov
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Correspondence to Andrei V. Alexandrov.

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Balucani, C., Alexandrov, A.V. Ultrasound- and Microspheres-Enhanced Thrombolysis for Stroke Treatment: State of the Art. Curr Cardiol Rep 12, 34–41 (2010). https://doi.org/10.1007/s11886-009-0082-0

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