A Model of High-Speed Endovascular Sonothrombolysis with Vortex Ultrasound-Induced Shear Stress to Treat Cerebral Venous Sinus Thrombosis

Abstract

This research aims to demonstrate a novel vortex ultrasound enabled endovascular thrombolysis method designed for treating cerebral venous sinus thrombosis (CVST). This is a topic of substantial importance since current treatment modalities for CVST still fail in as many as 20% to 40% of the cases, and the incidence of CVST has increased since the outbreak of the coronavirus disease 2019 pandemic. Compared with conventional anticoagulant or thrombolytic drugs, sonothrombolysis has the potential to remarkably shorten the required treatment time owing to the direct clot targeting with acoustic waves. However, previously reported strategies for sonothrombolysis have not demonstrated clinically meaningful outcomes (e.g., recanalization within 30 min) in treating large, completely occluded veins or arteries. Here, we demonstrated a new vortex ultrasound technique for endovascular sonothrombolysis utilizing wave-matter interaction-induced shear stress to enhance the lytic rate substantially. Our in vitro experiment showed that the lytic rate was increased by at least 64.3% compared with the nonvortex endovascular ultrasound treatment. A 3.1-g, 7.5-cm-long, completely occluded in vitro 3-dimensional model of acute CVST was fully recanalized within 8 min with a record-high lytic rate of 237.5 mg/min for acute bovine clot in vitro. Furthermore, we confirmed that the vortex ultrasound causes no vessel wall damage over ex vivo canine veins. This vortex ultrasound thrombolysis technique potentially presents a new life-saving tool for severe CVST cases that cannot be efficaciously treated using existing therapies.

Focused Ultrasound, an Emerging Tool for Atherosclerosis Treatment: A Comprehensive Review

“…HIFU transducers are designed to converge ultrasound beams at a focal point where localized biological effects occur to ensure precise targeting. Different beam-focusing methods, such as geometric focusing, acoustic lens focusing, and electronic focusing, are employed to achieve this [ 48 ]. Geometric focusing uses the shape of the transducer’s surface to concentrate the ultrasound waves [ 49 ].…”

“…Decreases in hepatic arterial and portal venous flow resistance [74] Furthermore, one recent study used that vortex ultrasound causes no vessel wall damage over ex vivo canine veins. This vortex ultrasound thrombolysis technique potentially achieved recanalization of blood flow in cerebral venous sinus thrombosis (CVST) [48]. Another study investigated ultrasound-targeted microbubble cavitation during machine perfusion to reduce microvascular thrombi and graft injury in a rat liver donation model after circulatory death (DCD).…”

Underwater double vortex generation using 3D printed acoustic lens and field multiplexing

“…28 Although considerable research has focused on acoustic vortices, the majority of studies have employed them at low intensities. 29,30 The generation of acoustic vortices at higher intensities could be more advantageous for biomedical ultrasound-related applications. For example, a higher acoustic energy can facilitate the production of cavitation, an effect beneficial for many ultrasonic medical applications, including tumor ablation 31,32 and tissue liquefaction.…”