Taboos and opportunities in sonothrombolysis for stroke.

Area of Science:

• Neurology
• Biomedical Engineering
• Cardiovascular Research

Background:

• Systemic thrombolysis with tissue plasminogen activator (tPA) is the primary treatment for acute ischemic stroke within 4.5 hours of symptom onset.
• Despite treatment, over half of patients experience unfavorable long-term outcomes, highlighting the need for improved therapies.
• Sonothrombolysis, utilizing ultrasound to enhance tPA's clot-dissolving effects, shows potential for improving recanalization rates and functional outcomes.

Purpose of the Study:

• To review current knowledge on sonothrombolysis for acute ischemic stroke.
• To identify potentially harmful approaches and promising future directions in ultrasound-enhanced thrombolysis.
• To discuss novel technologies, including operator-independent devices, for wider adoption of sonothrombolysis.

Main Methods:

• Review of existing literature on sonothrombolysis and its combination with systemic tPA.
• Analysis of different ultrasound frequencies, intensities, and adjuvant treatments.
• Evaluation of the safety and efficacy of novel sonothrombolytic approaches.

Main Results:

• The combination of 2 MHz ultrasound and systemic tPA demonstrates a trend towards better functional outcomes.
• Higher recanalization rates are associated with improved patient outcomes.
• Concerns exist regarding the efficacy and safety of some novel sonothrombolytic strategies, potentially delaying clinical translation.

Conclusions:

• Sonothrombolysis represents a promising strategy to augment current acute ischemic stroke treatment.
• Further research is needed to optimize ultrasound parameters and adjuvant therapies for maximum benefit.
• Operator-independent devices could facilitate broader clinical application of sonothrombolysis, improving stroke care accessibility.