Sonothrombolysis for Acute Ischemic Stroke: A Critical Appraisal

Abstract

Sonothrombolysis is the adjunct use of ultrasound during thrombolysis as an augmentation technique that can facilitate clot dissolution. When no thrombolytics are used, we refer to this technique as sonolysis. In the setting of acute ischemic stroke (AIS), various ultrasound protocols have been tested with different devices and parameters, with or without the concomitant use of ultrasound contrast material. After years of clinical research, much is known regarding the safety profile of low-intensity and high-frequency (2 MHz) sonothrombolysis but efficacy remains to be proved. This review provides an overview of clinical trials and meta-analyses of sonothrombolysis. As we are entering a new era of combined intravenous and interventional AIS therapies, it is a challenge for researchers to incorporate sonothrombolysis in the constantly evolving AIS protocols. Proving the efficacy of sonothrombolysis in a well-designed randomized controlled clinical trial of a next-generation noninvasive therapeutic device or a drug-device combination would have substantial impact on future AIS management.