Focused Ultrasound Therapy

Early Stage squareFocused ultrasound is an early-stage, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with thromboembolic stroke. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue. Where the beams converge, the ultrasound can produce a variety of therapeutic effects. The use of focused ultrasound for disrupting blood clots, inducing reperfusion of occluded vessels, and temporarily opening the blood-brain barrier to allow entry of stem cells to populate the area of the stroke are all early stage ideas for treatment. More work is needed to optimize these biomechanisms of focused ultrasound before research can reach the clinic. Please note that there is another major cause of stroke, listed separately under “Stroke, intracellular hemorrhage.” 

The primary options for treatment of stroke include medications with the possible inclusion of surgery.

For certain patients, focused ultrasound could provide additional treatment options that may have reduced complications and a lower cost.

Advantages:

  • Focused ultrasound is noninvasive, so it does not carry added concerns like surgical wound healing or infection.
  • Focused ultrasound can reach the desired target without damaging surrounding tissue.
  • Focused ultrasound can be repeated, if necessary.

Clinical Trials

At the present time, there are no clinical trials recruiting patients for focused ultrasound treatment of thromboembolic stroke.

Regulatory Approval and Reimbursement

Focused ultrasound treatment for thromboembolic stroke is not yet approved by regulatory bodies or covered by medical insurance companies.

Notable Papers

Guo S, Guo X, Wang X, Zhou D, Du X, Han M, Zong Y, Wan M. Reduced clot debris size in sonothrombolysis assisted with phase-change nanodroplets. Ultrason Sonochem. 2019 Jun;54:183-191. doi: 10.1016/j.ultsonch.2019.02.001. Epub 2019 Feb 2.

Gerhardson T, Sukovich JR, Chaudhary N, Chenevert TL, Ives K, Hall TL, Camelo-Piragua S, Xu Z, Pandey AS. Histotripsy Clot Liquefaction in a Porcine Intracerebral Hemorrhage Model. Neurosurgery. 2019 Mar 29. pii: nyz089. doi: 10.1093/neuros/nyz089.

Juratli MA, Menyaev YA, Sarimollaoglu M, Melerzanov AV, Nedosekin DA, Culp WC, Suen JY, Galanzha EI, Zharov VP. Noninvasive label-free detection of circulating white and red blood clots in deep vessels with a focused photoacoustic probe. Biomed Opt Express. 2018 Oct 23;9(11):5667-5677. doi: 10.1364/BOE.9.005667. eCollection 2018 Nov 1.

Baek H, Sariev A, Kim MJ, Lee H, Kim J, Kim H. A neuroprotective brain stimulation for vulnerable cerebellar Purkinje cell after ischemic stroke: a study with low-intensity focused ultrasound. Conf Proc IEEE Eng Med Biol Soc. 2018 Jul;2018:4744-4747. doi: 10.1109/EMBC.2018.8513138.

Zafar A, Quadri SA, Farooqui M, Ortega-Gutiérrez S, Hariri OR, Zulfiqar M, Ikram A, Khan MA, Suriya SS, Nunez-Gonzalez JR, Posse S, Mortazavi MM, Yonas H. MRI-Guided High-Intensity Focused Ultrasound as an Emerging Therapy for Stroke: A Review. J Neuroimaging. 2018 Oct 8. doi: 10.1111/jon.12568.

Baek H, Pahk KJ, Kim MJ, Youn I, Kim H. Modulation of Cerebellar Cortical Plasticity Using Low-Intensity Focused Ultrasound for Poststroke Sensorimotor Function Recovery. Neurorehabil Neural Repair. 2018 Sep;32(9):777-787. doi: 10.1177/1545968318790022. Epub 2018 Aug 29.

Ilyas A, Chen CJ, Ding D, Romeo A, Buell TJ, Wang TR, Kalani MYS, Park MS. Magnetic resonance-guided, high-intensity focused ultrasound sonolysis: potential applications for stroke. Neurosurg Focus. 2018 Feb;44(2):E12. doi: 10.3171/2017.11.FOCUS17608.

Li H, Sun J, Zhang D, Omire-Mayor D, Lewin PA, Tong S. Low-intensity (400 mW/cm2, 500 kHz) pulsed transcranial ultrasound preconditioning may mitigate focal cerebral ischemia in rats. Brain Stimul. 2017 Feb 27. pii: S1935-861X(17)30615-0. doi: 10.1016/j.brs.2017.02.008.

Yang W, Zhou Y. Effect of pulse repetition frequency of high-intensity focused ultrasound on in vitro thrombolysis. Ultrason Sonochem. 2017 Mar;35(Pt A):152-160. doi: 10.1016/j.ultsonch.2016.09.014.

Papadopoulos N, Yiallouras C, Damianou C. The Enhancing Effect of Focused Ultrasound on TNK-Tissue Plasminogen Activator-Induced Thrombolysis Using an In Vitro Circulating Flow Model. J Stroke Cerebrovasc Dis. 2016 Sep 2. pii: S1052-3057(16)30270-1. doi: 10.1016/j.jstrokecerebrovasdis.2016.07.052.

Papadopoulos N, Damianou C. In Vitro Evaluation of Focused Ultrasound-Enhanced TNK-Tissue Plasminogen Activator-Mediated Thrombolysis. J Stroke Cerebrovasc Dis. 2016 Aug;25(8):1864-77. doi: 10.1016/j.jstrokecerebrovasdis.2016.03.051.

Click here for additional references from PubMed.

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