Transcranial ultrasound-improved thrombolysis: diagnostic vs. therapeutic ultrasound

Behrens, Stephan; Spengos, Konstantinos; Daffertshofer, Michael; Schroeck, Helmut; Dempfle, Carl Erik; Hennerici, Michael G.

doi:10.1016/s0301-5629(01)00481-1

Cited by 117 publications

(79 citation statements)

References 29 publications

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“…Also, the possibility of damage to bone and soft tissue has not been excluded, since they were not evaluated in the present study. Since 185 kHz ultrasound insonation (2 W/cm 2 ) was reported to potentiate transcranial ultrasound-improved thrombolysis without tissue damage, 29 the ultrasound parameters such as frequency still need to be optimized. Second, we did not examine other echo contrast microbubbles such as Levovist, since they were reported not to enhance the transfer efficiency into cultured human vascular smooth muscle cells and endothelial cells.…”

Section: Discussionmentioning

confidence: 99%

Development of efficient plasmid DNA transfer into adult rat central nervous system using microbubble-enhanced ultrasound

et al. 2004

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Section: Discussionmentioning

confidence: 99%

Development of efficient plasmid DNA transfer into adult rat central nervous system using microbubble-enhanced ultrasound

et al. 2004

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“…Ultrasound has been demonstrated to enhance thrombolysis when used in conjunction with a thrombolytic agent both in vitro and in vivo [23][24][25][26][27]. Ultrasound delivered intravascularly through miniaturized transducers attached to a catheter has demonstrated effective and safe thrombolysis [28].…”

Section: Discussionmentioning

confidence: 99%

Ultrasound-facilitated thrombolysis using tissue-plasminogen activator-loaded echogenic liposomes

Tiukinhoy-Laing¹,

Huang²,

Klegerman³

et al. 2007

Thrombosis Research

122

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Introduction-Targeted delivery of thrombolytics to the site of occlusion is an attractive concept, with implications for the treatment of many thrombo-occlusive diseases. Ultrasound enhances thrombolysis, which can be augmented by the addition of a contrast agent. We have previously reported development of echogenic liposomes (ELIP) for targeted highlighting of structures with potential for drug and gene delivery. This study evaluated the potential of ELIP for thrombolytic loading, and the effect of ultrasound exposure of thrombolytic-loaded ELIP on thrombolytic efficacy.

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“…Meanwhile, frequencies of 1-2.2 MHz can also enhance TPA-induced thrombus dissolution through various mechanisms, such as fluid streaming around clot surface, disaggregation of fibrin fibers, and creating more binding sites for TPA without heating or cavitation. 24,25 This frequency range is safely and routinely used for diagnostic ultrasound examinations.…”

Section: Experimental Evidence For Enhancement Of Thrombolysis With Umentioning

confidence: 99%

Ultrasound-Enhanced Thrombolysis in Acute Ischemic Stroke: Potential, Failures, and Safety

Tsivgoulis

Alexandrov

2007

Neurotherapeutics

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Summary:Experimental and pilot clinical evidence shows that thrombolysis with intravenous tissue plasminogen activator (TPA) can be enhanced with ultrasound. Ultrasound delivers mechanical pressure waves to the clot, thus exposing more thrombus surface to circulating drug. The international multicenter phase II CLOTBUST trial showed that, in patients with acute ischemic stroke, transcranial Doppler (TCD) monitoring augments TPA-induced arterial recanalization, with a nonsignificant trend toward an increased rate of recovery from stroke, compared with placebo. In the CLOTBUST trial, the dramatic clinical recovery from stroke coupled with complete recanalization within 2 hours after TPA bolus occurred in 25% of patients treated with TPA ϩ TCD (n ϭ 63), compared with 8% of those who received TPA alone (n ϭ 63, P ϭ 0.02). Different results were achieved in smaller studies that used transcranial color-coded duplex sonography (TCCD) and a nonimaging therapeutic ultrasound system. The findings of the TRUMBI trial (26 patients) underscored the adverse bioeffects of midkilohertz (300 kHz) ultrasound, such as promotion of bleeding in brain areas both affected and unaffected by ischemia. Exposure to multifrequency, multielement duplex ultrasound resulted in a trend toward a higher risk of hemorrhagic transformation. To further enhance the ability of TPA to break up thrombi, current ongoing clinical trials include phase II studies of a single-beam, 2-MHz TCD with perflutren lipid microspheres. Enhancement of intra-arterial TPA delivery is being clinically tested with 1.7-2.1 MHz pulsed-wave ultrasound (EKOS catheter). Multinational dose escalation studies of microspheres and the development of an operator-independent ultrasound device are underway.

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Transcranial ultrasound-improved thrombolysis: diagnostic vs. therapeutic ultrasound

Cited by 117 publications

References 29 publications

Development of efficient plasmid DNA transfer into adult rat central nervous system using microbubble-enhanced ultrasound

Development of efficient plasmid DNA transfer into adult rat central nervous system using microbubble-enhanced ultrasound

Ultrasound-facilitated thrombolysis using tissue-plasminogen activator-loaded echogenic liposomes

Ultrasound-Enhanced Thrombolysis in Acute Ischemic Stroke: Potential, Failures, and Safety

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