MRI-Guided High-Intensity Focused Ultrasound as an Emerging Therapy for Stroke: A Review.

Author: Zafar A1, Quadri SA1,2,3, Farooqui M1, Ortega-Gutiérrez S4, Hariri OR5, Zulfiqar M6, Ikram A1, Khan MA1,2,3, Suriya SS1,2,3, Nunez-Gonzalez JR1, Posse S1, Mortazavi MM2,3, Yonas H7
1Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM.
2California Institute of Neuroscience, Thousand Oaks, CA.
3National Skull Base Center, Thousand Oaks, CA.
4Department of Neurology, University of Iowa, Iowa City, IA.
5Department of Neurosurgery, Stanford University School of Medicine, Stanford, CA.
6Department of Neurology, University of Pittsburgh Medical Center, Pittsburgh, PA.
7Department of Neurosurgery, University of New Mexico, Albuquerque, NM.
Conference/Journal: J Neuroimaging.
Date published: 2018 Oct 8
Other: Special Notes: doi: 10.1111/jon.12568. [Epub ahead of print] , Word Count: 231

Stroke, either ischemic or hemorrhagic, accounts for significantly high morbidity and mortality rates around the globe effecting millions of lives annually. For the past few decades, ultrasound has been extensively investigated to promote clot lysis for the treatment of stroke, myocardial infarction, and acute peripheral arterial occlusions, with or without the use of tPA or contrast agents. In the age of modern minimal invasive techniques, magnetic resonance imaging-guided high-intensity focused ultrasound is a new emerging modality that seems to promise therapeutic utilities for both ischemic and hemorrhagic stroke. High-intensity focused ultrasound causes thermal heating as the tissue absorbs the mechanical energy transmitted by the ultrasonic waves leading to tissue denaturation and coagulation. Several in-vitro and in-vivo studies have demonstrated the viability of this technology for sonothrombolysis in both types of stroke and have warranted clinical trials. Apart from safety and efficacy, initiation of trials would further enable answers regarding its practical application in a clinical setup. Though this technology has been under study for treatment of various brain diseases for some decades now, relatively very few neurologists and even neurosurgeons seem to be acquainted with it. The aim of this review is to provide basic understanding of this powerful technology and discuss its clinical application and potential role as an emerging viable therapeutic option for the future management of stroke.

KEYWORDS: Focused ultrasound; Insightec; hemorrhage; stroke; thermal ablation

PMID: 30295987 DOI: 10.1111/jon.12568