Ultrasound (US) applied as an adjunct to
thrombolytic therapy improves the recanalization of occluded vessels, and
microbubbles can amplify this effect. New data suggests that the combination of US and
microbubbles without
tissue plasminogen activator may achieve recanalization with a lower risk of
hemorrhage. Further possibilities include specific targeting of
thrombus with immunobubbles as well as local
drug delivery with US-sensitive
liposomes. Clinical studies support the use of US for
ischemic stroke therapy, and the first trials of enhancing sonothrombolysis with
microbubbles have been encouraging. One emerging clinical application is sonothrombolysis of
intracranial hemorrhages for clot evacuation. Microcirculation, irrespective of recanalization, may also be improved by US and
microbubbles, and this effect may open new opportunities for the application of sonothrombolysis in
acute ischemic stroke. Understanding the mechanisms of therapeutic action and relating this knowledge to issues of efficacy and safety are important objectives of ongoing research. This review will discuss the translational capacities of in vitro studies and preclinical research and will assess the first clinical studies of this promising therapeutic strategy.