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Hu YY, Yang G, Liang XS, Ding XS, Xu DE, Li Z, Ma QH, Chen R, Sun YY. Transcranial low-intensity ultrasound stimulation for treating central nervous system disorders: A promising therapeutic application. Front Neurol 2023; 14:1117188. [PMID: 36970512 PMCID: PMC10030814 DOI: 10.3389/fneur.2023.1117188] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2022] [Accepted: 02/10/2023] [Indexed: 03/29/2023] Open
Abstract
Transcranial ultrasound stimulation is a neurostimulation technique that has gradually attracted the attention of researchers, especially as a potential therapy for neurological disorders, because of its high spatial resolution, its good penetration depth, and its non-invasiveness. Ultrasound can be categorized as high-intensity and low-intensity based on the intensity of its acoustic wave. High-intensity ultrasound can be used for thermal ablation by taking advantage of its high-energy characteristics. Low-intensity ultrasound, which produces low energy, can be used as a means to regulate the nervous system. The present review describes the current status of research on low-intensity transcranial ultrasound stimulation (LITUS) in the treatment of neurological disorders, such as epilepsy, essential tremor, depression, Parkinson's disease (PD), and Alzheimer's disease (AD). This review summarizes preclinical and clinical studies using LITUS to treat the aforementioned neurological disorders and discusses their underlying mechanisms.
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Affiliation(s)
- Yun-Yun Hu
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
| | - Gang Yang
- Lab Center, Medical College of Soochow University, Suzhou, China
| | - Xue-Song Liang
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
- Second Clinical College, Dalian Medical University, Dalian, Liaoning, China
| | - Xuan-Si Ding
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
| | - De-En Xu
- Wuxi No. 2 People's Hospital, Wuxi, Jiangsu, China
| | - Zhe Li
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Sleep Medicine Center, Suzhou Guangji Hospital, The Affiliated Guangji Hospital of Soochow University, Suzhou, China
| | - Quan-Hong Ma
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
- Quan-Hong Ma
| | - Rui Chen
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- *Correspondence: Rui Chen
| | - Yan-Yun Sun
- Department of Neurology and Clinical Research Center of Neurological Disease, The Second Affiliated Hospital of Soochow University, Suzhou, China
- Jiangsu Key Laboratory of Neuropsychiatric Diseases, Institute of Neuroscience, Soochow University, Suzhou, Jiangsu, China
- Yan-Yun Sun
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Shin Low S, Nong Lim C, Yew M, Siong Chai W, Low LE, Manickam S, Ti Tey B, Show PL. Recent ultrasound advancements for the manipulation of nanobiomaterials and nanoformulations for drug delivery. ULTRASONICS SONOCHEMISTRY 2021; 80:105805. [PMID: 34706321 PMCID: PMC8555278 DOI: 10.1016/j.ultsonch.2021.105805] [Citation(s) in RCA: 36] [Impact Index Per Article: 12.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/28/2021] [Revised: 10/08/2021] [Accepted: 10/20/2021] [Indexed: 05/04/2023]
Abstract
Recent advances in ultrasound (US) have shown its great potential in biomedical applications as diagnostic and therapeutic tools. The coupling of US-assisted drug delivery systems with nanobiomaterials possessing tailor-made functions has been shown to remove the limitations of conventional drug delivery systems. The low-frequency US has significantly enhanced the targeted drug delivery effect and efficacy, reducing limitations posed by conventional treatments such as a limited therapeutic window. The acoustic cavitation effect induced by the US-mediated microbubbles (MBs) has been reported to replace drugs in certain acute diseases such as ischemic stroke. This review briefly discusses the US principles, with particular attention to the recent advancements in drug delivery applications. Furthermore, US-assisted drug delivery coupled with nanobiomaterials to treat different diseases (cancer, neurodegenerative disease, diabetes, thrombosis, and COVID-19) are discussed in detail. Finally, this review covers the future perspectives and challenges on the applications of US-mediated nanobiomaterials.
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Affiliation(s)
- Sze Shin Low
- Continental-NTU Corporate Lab, Nanyang Technological University, 50 Nanyang Drive, Singapore 637553, Singapore; Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia
| | - Chang Nong Lim
- School of Engineering and Physical Sciences, Heriot-Watt University Malaysia, No. 1, Jalan Venna P5/2, Precinct 5, Putrajaya 62200, Malaysia
| | - Maxine Yew
- Department of Mechanical, Materials and Manufacturing Engineering, University of Nottingham Ningbo China, 199 Taikang East Road, Ningbo 315100, Zhejiang, China
| | - Wai Siong Chai
- School of Mechanical Engineering and Automation, Harbin Institute of Technology, Shenzhen, Shenzhen 518055, Guangdong, China
| | - Liang Ee Low
- Biofunctional Molecule Exploratory (BMEX) Research Group, School of Pharmacy, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Institute of Pharmaceutics, College of Pharmaceutical Sciences, Zhejiang University, 866 Yuhangtang Road, Hangzhou 310058, Zhejiang, China.
| | - Sivakumar Manickam
- Petroleum and Chemical Engineering, Faculty of Engineering, Universiti Teknologi Brunei, Jalan Tungku Link Gadong, Bandar Seri Begawan, BE1410, Brunei Darussalam.
| | - Beng Ti Tey
- Advanced Engineering Platform, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia; Chemical Engineering Discipline, School of Engineering, Monash University Malaysia, Jalan Lagoon Selatan, Bandar Sunway 47500, Selangor Darul Ehsan, Malaysia
| | - Pau Loke Show
- Department of Chemical and Environmental Engineering, Faculty of Science and Engineering, University of Nottingham Malaysia, Jalan Broga, Semenyih 43500, Selangor Darul Ehsan, Malaysia.
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Goel L, Jiang X. Advances in Sonothrombolysis Techniques Using Piezoelectric Transducers. SENSORS 2020; 20:s20051288. [PMID: 32120902 PMCID: PMC7085655 DOI: 10.3390/s20051288] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Abstract
One of the great advancements in the applications of piezoelectric materials is the application for therapeutic medical ultrasound for sonothrombolysis. Sonothrombolysis is a promising ultrasound based technique to treat blood clots compared to conventional thrombolytic treatments or mechanical thrombectomy. Recent clinical trials using transcranial Doppler ultrasound, microbubble mediated sonothrombolysis, and catheter directed sonothrombolysis have shown promise. However, these conventional sonothrombolysis techniques still pose clinical safety limitations, preventing their application for standard of care. Recent advances in sonothrombolysis techniques including targeted and drug loaded microbubbles, phase change nanodroplets, high intensity focused ultrasound, histotripsy, and improved intravascular transducers, address some of the limitations of conventional sonothrombolysis treatments. Here, we review the strengths and limitations of these latest pre-clincial advancements for sonothrombolysis and their potential to improve clinical blood clot treatments.
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Affiliation(s)
- Leela Goel
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, USA;
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695-7910, USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, USA;
- Correspondence: ; Tel.: +1-919-515-5240
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Teng Y, Jin H, Nan D, Li M, Fan C, Liu Y, Lv P, Cui W, Sun Y, Hao H, Qu X, Yang Z, Huang Y. In vivo evaluation of urokinase-loaded hollow nanogels for sonothrombolysis on suture embolization-induced acute ischemic stroke rat model. Bioact Mater 2017; 3:102-109. [PMID: 29744447 PMCID: PMC5935765 DOI: 10.1016/j.bioactmat.2017.08.001] [Citation(s) in RCA: 30] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Revised: 08/09/2017] [Accepted: 08/17/2017] [Indexed: 12/25/2022] Open
Abstract
The urokinase-type plasminogen activator (uPA) loaded hollow nanogels (nUK) were synthesized by a one-step reaction of glycol chitosan and aldehyde capped poly (ethylene oxide). The resultant formulation is sensitive to diagnostic ultrasound (US) of 2 MHz. Herein, we evaluated the in vivo sonothrombolysis performance of the nUK on acute ischemic stroke rat model which was established by suture embolization of middle cerebral artery (MCA). Via intravenous (i.v.) administration, the experimental data prove a controlled release of the therapeutic protein around the clots under ultrasound stimulation, leading to enhanced thrombolysis efficiency of the nUK, evidenced from smaller infarct volume and better clinical scores when compared to the i.v. dose of free uPA no matter with or without US intervention. Meanwhile, the preservation ability of the nanogels not only prolonged the circulation duration of the protein, but also resulted in the better blood-brain barrier protection of the nUK formulation, showing no increased risk on the hemorrhagic transformation than the controls. This work suggests that the nUK is a safe sonothrombolytic formulation for the treatment of acute ischemic stroke. Ultrasonic responsive urokinase (uPA)-loaded hollow nanogels (nUK) were synthesized for stroke treatment. Acute ischemic stroke rat model was established by suture embolization of middle cerebral artery. The nUK enhanced the sonothrombolytic efficacy and led to better BBB protection compared to the free uPA.
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Key Words
- BBB, blood-brain barrier
- CCA, common carotid artery
- EB, evens blue
- ELIP, echogenic liposomes
- HT, hemorrhagic transformation
- Hb, hemoglobin
- Hollow nanogel
- In vivo evaluation
- MCA, middle cerebral artery
- MCAO, middle cerebral artery occlusion
- MRI, magnetic resonance imaging
- SD, Sprague-Dawley
- TCD, Transcranial Doppler
- TTC, 2,3,5-triphenyltetrazolium chloride
- Thrombolysis
- UK+US, ultrasound and free urokinase
- UK, urokinase
- US, ultrasound
- Ultrasound responsive
- Urokinase delivery
- nUK+US, ultrasound and uPA-loaded nanogels
- nUK, uPA-loaded nanogels
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Affiliation(s)
- Yuming Teng
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Haiqiang Jin
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Ding Nan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Mengnan Li
- State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Chenghe Fan
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yuanyuan Liu
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Pu Lv
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Wei Cui
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Yongan Sun
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Hongjun Hao
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
| | - Xiaozhong Qu
- College of Materials and Opto-Electronic Technology, University of Chinese Academy of Sciences, Beijing 100049, China
| | - Zhenzhong Yang
- State Key Laboratory of Polymer Physics and Chemistry, Institute of Chemistry, Chinese Academy of Sciences, Beijing 100190, China
| | - Yining Huang
- Department of Neurology, Peking University First Hospital, Beijing 100034, China
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The Use of Intracranial Doppler as a Cause for Intraoperative Hyperthermia. J Neurosurg Anesthesiol 2017; 29:363-364. [DOI: 10.1097/ana.0000000000000298] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Jones RM, O'Reilly MA, Hynynen K. Experimental demonstration of passive acoustic imaging in the human skull cavity using CT-based aberration corrections. Med Phys 2016; 42:4385-400. [PMID: 26133635 DOI: 10.1118/1.4922677] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/07/2022] Open
Abstract
PURPOSE Experimentally verify a previously described technique for performing passive acoustic imaging through an intact human skull using noninvasive, computed tomography (CT)-based aberration corrections Jones et al. [Phys. Med. Biol. 58, 4981-5005 (2013)]. METHODS A sparse hemispherical receiver array (30 cm diameter) consisting of 128 piezoceramic discs (2.5 mm diameter, 612 kHz center frequency) was used to passively listen through ex vivo human skullcaps (n = 4) to acoustic emissions from a narrow-band fixed source (1 mm diameter, 516 kHz center frequency) and from ultrasound-stimulated (5 cycle bursts, 1 Hz pulse repetition frequency, estimated in situ peak negative pressure 0.11-0.33 MPa, 306 kHz driving frequency) Definity™ microbubbles flowing through a thin-walled tube phantom. Initial in vivo feasibility testing of the method was performed. The performance of the method was assessed through comparisons to images generated without skull corrections, with invasive source-based corrections, and with water-path control images. RESULTS For source locations at least 25 mm from the inner skull surface, the modified reconstruction algorithm successfully restored a single focus within the skull cavity at a location within 1.25 mm from the true position of the narrow-band source. The results obtained from imaging single bubbles are in good agreement with numerical simulations of point source emitters and the authors' previous experimental measurements using source-based skull corrections O'Reilly et al. [IEEE Trans. Biomed. Eng. 61, 1285-1294 (2014)]. In a rat model, microbubble activity was mapped through an intact human skull at pressure levels below and above the threshold for focused ultrasound-induced blood-brain barrier opening. During bursts that led to coherent bubble activity, the location of maximum intensity in images generated with CT-based skull corrections was found to deviate by less than 1 mm, on average, from the position obtained using source-based corrections. CONCLUSIONS Taken together, these results demonstrate the feasibility of using the method to guide bubble-mediated ultrasound therapies in the brain. The technique may also have application in ultrasound-based cerebral angiography.
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Affiliation(s)
- Ryan M Jones
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada and Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 1L7, Canada
| | - Meaghan A O'Reilly
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada
| | - Kullervo Hynynen
- Physical Sciences Platform, Sunnybrook Research Institute, Toronto, Ontario M4N 3M5, Canada; Department of Medical Biophysics, University of Toronto, Toronto, Ontario M5G 1L7, Canada; and Institute of Biomaterials and Biomedical Engineering, University of Toronto, Toronto, Ontario M5S 3G9, Canada
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Ansar S, Chatzikonstantinou E, Wistuba-Schier A, Mirau-Weber S, Fatar M, Hennerici MG, Meairs S. Characterization of a new model of thromboembolic stroke in C57 black/6J mice. Transl Stroke Res 2014; 5:526-33. [PMID: 24347404 PMCID: PMC4092233 DOI: 10.1007/s12975-013-0315-9] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/01/2013] [Revised: 11/18/2013] [Accepted: 11/29/2013] [Indexed: 11/29/2022]
Abstract
This study characterizes a new model of thromboembolic stroke of the middle cerebral artery in C57 black/6J mice, thus offering an opportunity to use the model for studying ischemic stroke in transgenic mice. Thromboembolic stroke was induced by local injection of either 1.5 or 3.0 UI of thrombin directly into the right MCA of C57 black/6J mice. Cerebral blood flow (CBF) velocity was measured continuously by laser Doppler flowmetry, which allowed documentation of both MCA occlusion and of spontaneous recanalization. After 24 h, all animals were euthanized. Cryosections were cut at 400-μm intervals and silver stained with the high-contrast method for volumetric assessment of infarct size. Interleukin (IL)-6, tumor necrosis factor-alpha (TNF-α), caspase-3 and hsp 70 protein levels were investigated by immunofluorescence. Thrombin injection resulted in clot formation in all animals. Cortical infarction occurred in 63% of the mice while 37% had a spontaneous MCA recanalization during the first 20 min following thrombin injection. In cases of successful MCA occlusion with consequent infarction, the clot was stable up to 2 h after formation. Subsequently, 20% recanalized spontaneously. Infarctions were restricted to the cortex with a mean lesion volume of 36 ± 5 for 1.5 UI and 56 ± 8 for 3.0 UI thrombin. Protein levels of IL-6, TNF-α, caspase-3, and hsp 70 were significantly increased after MCAO. The results demonstrate that the mouse thromboembolic stroke model produces cortical infarctions of consistent size in C57 black/6J mice, which is dependent upon the amount of thrombin used for clot formation. Spontaneous MCA recanalization occurs after 2 h of ischemia in 20% of mice. Thus, the thromboembolic model is an applicable stroke model for C57 black/6J mice, which mimics many of the features of human stroke, including spontaneous recanalization. However, strain differences between Swiss and C57 black/6J mice must be taken into account when using the model.
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Affiliation(s)
- Saema Ansar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Eva Chatzikonstantinou
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Anja Wistuba-Schier
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Silvia Mirau-Weber
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Marc Fatar
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Michael G. Hennerici
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
| | - Stephen Meairs
- Department of Neurology, Universitätsmedizin Mannheim, Heidelberg University, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany
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Kvistad CE, Thomassen L, Waje-Andreassen U, Logallo N, Naess H. Body temperature and major neurological improvement in tPA-treated stroke patients. Acta Neurol Scand 2014; 129:325-9. [PMID: 24111500 DOI: 10.1111/ane.12184] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/16/2013] [Indexed: 12/12/2022]
Abstract
BACKGROUND Major neurological improvement (MNI) at 24 hours represents a marker of early recanalization in ischaemic stroke. Although low body temperature is considered neuroprotective in cerebral ischaemia, some studies have suggested that higher body temperature may promote clot lysis in the acute phase of ischaemic stroke. We hypothesized that higher body temperature was associated with MNI in severe stroke patients treated with tPA, suggesting a beneficial effect of higher body temperature on clot lysis and recanalization. METHODS Patients with ischaemic stroke or transient ischaemic attack (TIA) treated with tPA between February 2006 and August 2012 were prospectively included and retrospectively analysed. Body temperature was measured upon admission. MNI was defined by a ≥8 point improvement in NIHSS score at 24 hours as compared to NIHSS score on admission. No significant improvement (no-MNI) was defined by either an increase in NIHSS score or a decrease of ≤2 points at 24 hours in patients with an admission NIHSS score of ≥8. RESULTS Of the 2351 patients admitted with ischaemic stroke or TIA, 347 patients (14.8%) were treated with tPA. A total of 32 patients (9.2%) had MNI and 56 patients (16.1%) had no-MNI. Patients with MNI had higher body temperatures compared with patients with no-MNI (36.7°C vs 36.3°C, P = 0.004). Higher body temperature was independently associated with MNI when adjusted for confounders (OR 5.16, P = 0.003). CONCLUSION Higher body temperature was independently associated with MNI in severe ischaemic stroke patients treated with tPA. This may suggest a beneficial effect of higher body temperature on clot lysis and recanalization.
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Affiliation(s)
- C. E. Kvistad
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - L. Thomassen
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | | | - N. Logallo
- Department of Neurology; Haukeland University Hospital; Bergen Norway
| | - H. Naess
- Department of Neurology; Haukeland University Hospital; Bergen Norway
- Centre for Age-Related Medicine; Stavanger University Hospital; Stavanger Norway
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Yitao H, Kefu M, Bingshan T, Xuejun F, Ying Z, Zhili C, Xin J, Guo Y. Effects of Batroxobin with Continuous Transcranial Doppler Monitoring in Patients with Acute Cerebral Stroke: A Randomized Controlled Trial. Echocardiography 2014; 31:1283-92. [PMID: 24684297 DOI: 10.1111/echo.12559] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Affiliation(s)
- He Yitao
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- 2nd Clinical Medical College of Jinan University; Shenzhen China
| | - Ma Kefu
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- 2nd Clinical Medical College of Jinan University; Shenzhen China
| | - Tang Bingshan
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- 2nd Clinical Medical College of Jinan University; Shenzhen China
| | - Fu Xuejun
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- 2nd Clinical Medical College of Jinan University; Shenzhen China
| | - Zhan Ying
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- 2nd Clinical Medical College of Jinan University; Shenzhen China
| | - Cai Zhili
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- 2nd Clinical Medical College of Jinan University; Shenzhen China
| | - Jiang Xin
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- Department of Cardiology; Shenzhen people's Hospital; Shenzhen China
| | - Yi Guo
- Department of Neurology; Shenzhen people's Hospital; Shenzhen China
- 2nd Clinical Medical College of Jinan University; Shenzhen China
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Lapchak PA, Kikuchi K, Butte P, Hölscher T. Development of transcranial sonothrombolysis as an alternative stroke therapy: incremental scientific advances toward overcoming substantial barriers. Expert Rev Med Devices 2014; 10:201-13. [DOI: 10.1586/erd.12.88] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
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Monteith SJ, Kassell NF, Goren O, Harnof S. Transcranial MR-guided focused ultrasound sonothrombolysis in the treatment of intracerebral hemorrhage. Neurosurg Focus 2013; 34:E14. [DOI: 10.3171/2013.2.focus1313] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Intracerebral hemorrhage remains a significant cause of morbidity and mortality. Current surgical therapies aim to use a minimally invasive approach to remove as much of the clot as possible without causing undue disruption to surrounding neural structures. Transcranial MR-guided focused ultrasound (MRgFUS) surgery is an emerging technology that permits a highly concentrated focal point of ultrasound energy to be deposited to a target deep within the brain without an incision or craniotomy. With appropriate ultrasound parameters it has been shown that MRgFUS can effectively liquefy large-volume blood clots through the human calvaria. In this review the authors discuss the rationale for using MRgFUS to noninvasively liquefy intracerebral hemorrhage (ICH), thereby permitting minimally invasive aspiration of the liquefied clot via a small drainage tube. The mechanism of action of MRgFUS sonothrombolysis; current investigational work with in vitro, in vivo, and cadaveric models of ICH; and the potential clinical application of this disruptive technology for the treatment of ICH are discussed.
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Affiliation(s)
- Stephen J. Monteith
- 1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Neal F. Kassell
- 1Department of Neurosurgery, University of Virginia Health System, Charlottesville, Virginia; and
| | - Oded Goren
- 2Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, Israel
| | - Sagi Harnof
- 2Department of Neurosurgery, Sheba Medical Center, Tel Hashomer, Israel
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Monteith S, Sheehan J, Medel R, Wintermark M, Eames M, Snell J, Kassell NF, Elias WJ. Potential intracranial applications of magnetic resonance–guided focused ultrasound surgery. J Neurosurg 2013; 118:215-21. [DOI: 10.3171/2012.10.jns12449] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Magnetic resonance–guided focused ultrasound surgery (MRgFUS) has the potential to create a shift in the treatment paradigm of several intracranial disorders. High-resolution MRI guidance combined with an accurate method of delivering high doses of transcranial ultrasound energy to a discrete focal point has led to the exploration of noninvasive treatments for diseases traditionally treated by invasive surgical procedures. In this review, the authors examine the current intracranial applications under investigation and explore other potential uses for MRgFUS in the intracranial space based on their initial cadaveric studies.
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Affiliation(s)
| | | | | | - Max Wintermark
- 2Neuroradiology, University of Virginia Health System; and
| | - Matthew Eames
- 3Focused Ultrasound Foundation, Charlottesville, Virginia
| | - John Snell
- 3Focused Ultrasound Foundation, Charlottesville, Virginia
| | - Neal F. Kassell
- 1Departments of Neurological Surgery and
- 3Focused Ultrasound Foundation, Charlottesville, Virginia
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Monteith SJ, Harnof S, Medel R, Popp B, Wintermark M, Lopes MBS, Kassell NF, Elias WJ, Snell J, Eames M, Zadicario E, Moldovan K, Sheehan J. Minimally invasive treatment of intracerebral hemorrhage with magnetic resonance-guided focused ultrasound. J Neurosurg 2013; 118:1035-45. [PMID: 23330996 DOI: 10.3171/2012.12.jns121095] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
OBJECT Intracerebral hemorrhage (ICH) is a major cause of death and disability throughout the world. Surgical techniques are limited by their invasive nature and the associated disability caused during clot removal. Preliminary data have shown promise for the feasibility of transcranial MR-guided focused ultrasound (MRgFUS) sonothrombolysis in liquefying the clotted blood in ICH and thereby facilitating minimally invasive evacuation of the clot via a twist-drill craniostomy and aspiration tube. METHODS AND RESULTS In an in vitro model, the following optimum transcranial sonothrombolysis parameters were determined: transducer center frequency 230 kHz, power 3950 W, pulse repetition rate 1 kHz, duty cycle 10%, and sonication duration 30 seconds. Safety studies were performed in swine (n = 20). In a swine model of ICH, MRgFUS sonothrombolysis of 4 ml ICH was performed. Magnetic resonance imaging and histological examination demonstrated complete lysis of the ICH without additional brain injury, blood-brain barrier breakdown, or thermal necrosis due to sonothrombolysis. A novel cadaveric model of ICH was developed with 40-ml clots implanted into fresh cadaveric brains (n = 10). Intracerebral hemorrhages were successfully liquefied (> 95%) with transcranial MRgFUS in a highly accurate fashion, permitting minimally invasive aspiration of the lysate under MRI guidance. CONCLUSIONS The feasibility of transcranial MRgFUS sonothrombolysis was demonstrated in in vitro and cadaveric models of ICH. Initial in vivo safety data in a swine model of ICH suggest the process to be safe. Minimally invasive treatment of ICH with MRgFUS warrants evaluation in the setting of a clinical trial.
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Affiliation(s)
- Stephen J Monteith
- Department of Neurological Surgery, University of Virginia Health System, Charlottesville, Virginia 22908, USA.
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Kvistad CE, Thomassen L, Waje-Andreassen U, Naess H. Low body temperature associated with severe ischemic stroke within 6 hours of onset: The Bergen NORSTROKE Study. Vasc Health Risk Manag 2012; 8:333-8. [PMID: 22701327 PMCID: PMC3373317 DOI: 10.2147/vhrm.s31614] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Background Hypothermia is considered neuroprotective and a potential treatment in cerebral ischemia. Some studies suggest that hyperthermia may promote clot lysis. We hypothesized that low body temperature would prolong time to spontaneous clot lysis resulting in an association between low body temperature and severe neurological deficits in the early phase of ischemic stroke. Methods In this prospective study, patients (n = 516) exhibiting ischemic stroke with symptom onset within 6 hours were included. Body temperature and National Institute of Health Stroke Scale (NIHSS) score were registered on admission. Because low body temperature on admission may be secondary to immobilization due to large stroke, separate analyses were performed on patients with cerebral hemorrhage admitted within 6 hours (n = 85). Results Linear regression showed that low body temperature on admission was independently associated with a high NIHSS score within 6 hours of stroke onset in patients with ischemic stroke (P < 0.001). The association persisted when NIHSS was measured at 24 hours after admission. No such associations were found in patients with cerebral hemorrhage admitted within 6 hours of stroke onset. Conclusion Our study suggests that low body temperature within 6 hours of symptom onset is associated with severe ischemic stroke. This is in support of our hypothesis, although other contributing mechanisms cannot be excluded.
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Affiliation(s)
- Christopher E Kvistad
- Department of Neurology, Haukeland University Hospital, University of Bergen, Bergen, Norway.
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Wang Z, Fukuda T, Azuma T, Furuhata H. Safety of low-frequency transcranial ultrasound in permanent middle cerebral artery occlusion in spontaneously hypertensive rats. Cerebrovasc Dis 2011; 33:23-9. [PMID: 22133698 DOI: 10.1159/000332034] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/24/2011] [Accepted: 08/15/2011] [Indexed: 11/19/2022] Open
Abstract
BACKGROUND Some studies suggest that low-frequency transcranial ultrasound (LFTUS) can enhance thrombolysis, but other studies suggest that it may have adverse effects on intracranial tissues. We previously reported that LFTUS with appropriate parameters was effective and safe in a normotensive rat model of thromboembolic middle cerebral artery occlusion (MCAO) stroke. The goal of this study was to test the safety of this strategy in a spontaneously hypertensive rat (SHR) model of permanent MCAO. METHODS Right MCAO was achieved in male SHRs using intraluminal nylon sutures. Rats exhibiting left hemiparesis were randomly assigned to one of four different groups: (1) normal saline (NS) group (n = 8), intravenous administration of NS as placebo at 3 h after MCAO; (2) NS+LFTUS group (n = 10), NS administration with simultaneous application of LFTUS (480.4 kHz, continuous wave, at an intensity of 0.3 W/cm(2)) for 1 h; (3) tissue plasminogen activator (tPA) group (n = 11), intravenous administration of alteplase (10 mg/kg body weight) over 1 h instead of NS; or (4) tPA+LFTUS group (n = 11), tPA administration and application of LFTUS. Twenty-four hours after treatment, neurological change was evaluated, and brains were removed and examined histologically. RESULTS There was no significant difference (p > 0.09) when comparing changes in neurologic status and body weight, infarct ratio, edema ratio, or hemorrhagic transformation among the four groups. CONCLUSIONS Our findings suggest that sonothrombolytic treatment with LFTUS with appropriate parameters is safe when used for the treatment of ischemic stroke in hypertensive rats under the undesired permanent MCAO condition.
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Affiliation(s)
- Zuojun Wang
- Medical Engineering Laboratory, Jikei University School of Medicine, Tokyo, Japan.
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Santana-Rodríguez N, Clavo B, Fernández-Pérez L, Rivero JC, Travieso MM, Fiuza MD, Villar J, García-Castellano JM, Hernández-Pérez O, Déniz A. Pulsed ultrasounds accelerate healing of rib fractures in an experimental animal model: an effective new thoracic therapy? J Thorac Cardiovasc Surg 2010; 141:1253-8. [PMID: 20708756 DOI: 10.1016/j.jtcvs.2010.06.028] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/23/2010] [Revised: 05/18/2010] [Accepted: 06/20/2010] [Indexed: 10/19/2022]
Abstract
OBJECTIVES Rib fractures are a frequent traumatic injury associated with a relatively high morbidity. Currently, the treatment of rib fractures is symptomatic. Since it has been reported that pulsed ultrasounds accelerates repair of limb fractures, we hypothesized that the application of pulsed ultrasounds will modify the course of healing in an animal model of rib fracture. METHODS We studied 136 male Sprague-Dawley rats. Animals were randomly assigned to different groups of doses (none, 50, 100, and 250 mW/cm(2) of intensity for 3 minutes per day) and durations (2, 10, 20, and 28 days) of treatment with pulsed ultrasounds. In every subgroup, we analyzed radiologic and histologic changes in the bone callus. In addition, we examined changes in gene expression of relevant genes involved in wound repair in both control and treated animals. RESULTS Histologic and radiologic consolidation was significantly increased by pulsed ultrasound treatment when applied for more than 10 days. The application of 50 mW/cm(2) was the most effective dose. Only the 100 and 250 mW/cm(2) doses were able to significantly increase messenger RNA expression of insulin-like growth factor 1, suppressor of cytokine signaling-2 and -3, and vascular endothelial growth factor and decrease monocyte chemoattractant protein-1 and collagen type II-alpha 1. CONCLUSIONS Our findings indicate that pulsed ultrasound accelerates the consolidation of rib fractures. This study is the first to show that pulsed ultrasound promotes the healing of rib fractures. From a translational point of view, this easy, cheap technique could serve as an effective new therapeutic modality in patients with rib fractures.
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Affiliation(s)
- Norberto Santana-Rodríguez
- Experimental Surgery Unit, Research Unit, Hospital Universitario Dr Negrín, Las Palmas de Gran Canaria, Spain.
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Medel R, Crowley RW, McKisic MS, Dumont AS, Kassell NF. Sonothrombolysis: an emerging modality for the management of stroke. Neurosurgery 2009; 65:979-93; discussion 993. [PMID: 19834413 DOI: 10.1227/01.neu.0000350226.30382.98] [Citation(s) in RCA: 35] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022] Open
Abstract
OBJECTIVE Ischemic stroke and intracranial hemorrhage remain a persistent scourge in Western civilization. Therefore, novel therapeutic modalities are desperately needed to expand the current limitations of treatment. Sonothrombolysis possesses the potential to fill this void because it has experienced a dramatic evolution from the time of early conceptualization in the 1960s. This process began in the realm of peripheral and cardiovascular disease and has since progressed to encompass intracranial pathologies. Our purpose is to provide a comprehensive review of the historical progression and existing state of knowledge, including underlying mechanisms as well as evidence for clinical application of ultrasound thrombolysis. METHODS Using MEDLINE, in addition to cross-referencing existing publications, a meticulous appraisal of the literature was conducted. Additionally, personal communications were used as appropriate. RESULTS This appraisal revealed several different technologies close to broad clinical use. However, fundamental questions remain, especially in regard to transcranial high-intensity focused ultrasound. Currently, the evidence supporting low intensity ultrasound's potential in isolation, without tissue plasminogen, remains uncertain; however, possibilities exist in the form of microbubbles to allow for focal augmentation with minimal systemic consequences. Alternatively, the literature clearly demonstrates, the efficacy of high-intensity focused ultrasound for independent thrombolysis. CONCLUSION Sonothrombolysis exists as a promising modality for the noninvasive or minimally invasive management of stroke, both ischemic and hemorrhagic. Further research facilitating clinical application is warranted.
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Affiliation(s)
- Ricky Medel
- Department of Neurological Surgery, University of Virginia School of Medicine, Charlottesville, Virginia, USA
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Kunimatsu T, Yamashita A, Kitahama H, Misaki T, Yamamoto T. Measurement of cerebral reactive hyperemia at the initial post-ischemia reperfusion stage under normothermia and moderate hypothermia in rats. J Oral Sci 2009; 51:615-21. [DOI: 10.2334/josnusd.51.615] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/01/2022]
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Nedelmann M, Reuter P, Walberer M, Sommer C, Alessandri B, Schiel D, Ritschel N, Kempski O, Kaps M, Mueller C, Bachmann G, Gerriets T. Detrimental effects of 60 kHz sonothrombolysis in rats with middle cerebral artery occlusion. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:2019-2027. [PMID: 18723268 DOI: 10.1016/j.ultrasmedbio.2008.06.003] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/19/2007] [Revised: 05/21/2008] [Accepted: 06/08/2008] [Indexed: 05/26/2023]
Abstract
Recent studies have raised concerns about the safety of low frequency ultrasound in transcranial therapeutic application in cerebral ischemia. This study was designed to evaluate safety aspects and potential deleterious effects of low frequency, 60 kHz ultrasound in treatment of experimental middle cerebral artery occlusion (MCAO) in rats. Forty-five male Wistar rats were submitted to either temporary (90 min; groups I and II) or permanent MCAO (groups III and IV) using the suture technique. All animals received recombinant tissue plasminogen activator (rt-PA) starting 90 min after the beginning of occlusion. Groups I and III were additionally treated with 60 kHz ultrasound (time average acoustic intensity 0.14 W/cm(2), duty cycle 50%). Outcome assessment consisted of magnetic resonance imaging (MRI) and clinical evaluation after 5 and 24 h, and histology (perfusion fixation after 24 h). Overall mortality was higher in animals treated with ultrasound (43% versus 29% in controls). Most animals died during the insonation period (25% in group I, 36% in group III, no animals in the corresponding control groups; p < 0.05). Histology revealed disseminated microscopic intracerebral bleeding and subarachnoid hemorrhage as one possible cause of death. After temporary occlusion, the hemispheric ischemic lesion volume was more than doubled in animals treated with ultrasound (20.3% +/- 14.1% versus 8.6% +/- 5.1% in controls; p < 0.05). No difference in lesion volume was seen after permanent MCAO. Neurological assessment showed impairment of hearing as an additional specific side effect in ultrasound treated animals (65%, no impairment in controls). Although the results are not directly transferable to the human setting, this study clearly demonstrates the potential limitations of low frequency therapeutic ultrasound and the importance of pre-clinical safety assessment.
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Affiliation(s)
- Max Nedelmann
- Department of Experimental Neurology, Justus Liebig University, Giessen and Kerckhoff Clinic, Bad Nauheim, Germany.
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Datta S, Coussios CC, Ammi AY, Mast TD, de Courten-Myers GM, Holland CK. Ultrasound-enhanced thrombolysis using Definity as a cavitation nucleation agent. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:1421-33. [PMID: 18378380 PMCID: PMC2945910 DOI: 10.1016/j.ultrasmedbio.2008.01.016] [Citation(s) in RCA: 173] [Impact Index Per Article: 10.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/06/2023]
Abstract
Ultrasound has been shown previously to act synergistically with a thrombolytic agent, such as recombinant tissue plasminogen activator (rt-PA) to accelerate thrombolysis. In this in vitro study, a commercial contrast agent, Definity, was used to promote and sustain the nucleation of cavitation during pulsed ultrasound exposure at 120 kHz. Ultraharmonic signals, broadband emissions and harmonics of the fundamental were measured acoustically by using a focused hydrophone as a passive cavitation detector and used to quantify the level of cavitation activity. Human whole blood clots suspended in human plasma were exposed to a combination of rt-PA, Definity and ultrasound at a range of ultrasound peak-to-peak pressure amplitudes, which were selected to expose clots to various degrees of cavitation activity. Thrombolytic efficacy was determined by measuring clot mass loss before and after the treatment and correlated with the degree of cavitation activity. The penetration depth of rt-PA and plasminogen was also evaluated in the presence of cavitating microbubbles using a dual-antibody fluorescence imaging technique. The largest mass loss (26.2%) was observed for clots treated with 120-kHz ultrasound (0.32-MPa peak-to-peak pressure amplitude), rt-PA and stable cavitation nucleated by Definity. A significant correlation was observed between mass loss and ultraharmonic signals (r = 0.85, p < 0.0001, n = 24). The largest mean penetration depth of rt-PA (222 microm) and plasminogen (241 microm) was observed in the presence of stable cavitation activity. Stable cavitation activity plays an important role in enhancement of thrombolysis and can be monitored to evaluate the efficacy of thrombolytic treatment.
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Affiliation(s)
- Saurabh Datta
- Dept. of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Azzdine Y Ammi
- Dept. of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | - T. Douglas Mast
- Dept. of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
| | | | - Christy K. Holland
- Dept. of Biomedical Engineering, University of Cincinnati, Cincinnati, Ohio, USA
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Nedelmann M, Gerriets T, Kaps M. Therapeutische Ultraschallbehandlung des akuten Hirnarterienverschlusses. DER NERVENARZT 2008; 79:1399-400, 1402-6. [DOI: 10.1007/s00115-008-2550-y] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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Saguchi T, Onoue H, Urashima M, Ishibashi T, Abe T, Furuhata H. Effective and safe conditions of low-frequency transcranial ultrasonic thrombolysis for acute ischemic stroke: neurologic and histologic evaluation in a rat middle cerebral artery stroke model. Stroke 2008; 39:1007-11. [PMID: 18239172 DOI: 10.1161/strokeaha.107.496117] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Transcranial ultrasound (TUS) enhances thrombolysis and is expected to be useful for the treatment of ischemic stroke. However, neither its effectiveness in improving neurologic outcome nor its safety in living tissue has been fully established. We examined the efficacy and safety of low-frequency TUS under appropriate conditions of ultrasound for thrombolytic treatment in a rat middle cerebral artery stroke model. METHODS Sixty-five male Wistar rats were used. Rats with right middle cerebral artery stroke exhibiting left hemiparesis were blindly selected and randomly assigned to 1 of 3 groups: (1) control, no therapy; (2) tPA, intravenous administration of tissue plasminogen activator 3 hours after middle cerebral artery stroke, or (3) TUS, tPA administration and application of TUS (490 kHz, continuous wave, at an intensity of 0.8 W/cm(2)). Twenty-four hours after the onset of stroke, neurologic improvement was evaluated and brains were then removed. Thrombolysis at the origin of the right middle cerebral artery was examined. Thrombolysis ratio, cerebral infarct ratio, and rate of histologic evidence of hemorrhage were compared in the 3 groups. RESULTS Significantly better neurologic improvement (P=0.008), a higher thrombolysis ratio (P=0.041), and a reduction of cerebral infarct volume (P=0.047) were obtained in the TUS group compared with the tPA group, without an increase in hemorrhagic transformation. CONCLUSIONS Our findings suggest that thrombolytic treatment with low-frequency TUS under appropriate conditions could be an effective and safe method of treatment for ischemic stroke.
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Affiliation(s)
- Takayuki Saguchi
- Department of Neurosurgery, Jikei University School of Medicine, 3-25-8 Nishi-shinbashi, Minato-ku, Tokyo 105-8461, Japan.
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Jungehulsing GJ, Brunecker P, Nolte CH, Fiebach JB, Kunze C, Doepp F, Villringer A, Schreiber SJ. Diagnostic transcranial ultrasound perfusion-imaging at 2.5 MHz does not affect the blood-brain barrier. ULTRASOUND IN MEDICINE & BIOLOGY 2008; 34:147-50. [PMID: 17854981 DOI: 10.1016/j.ultrasmedbio.2007.07.006] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/04/2007] [Revised: 06/27/2007] [Accepted: 07/16/2007] [Indexed: 05/17/2023]
Abstract
The purpose was to assess whether standard ultrasound (US) perfusion-imaging by means of contrast-enhanced transcranial color-coded sonography (TCCS) affects the blood-brain barrier (BBB) in patients with small-vessel disease (SVD). One week after a screening MRI to exclude a preexisting BBB disruption, unilateral TCCS phase inversion harmonic imaging (PIHI) was performed in an axial diencephalic plane after intravenous bolus application of 2.5 mL SonoVue (IGEA, Bracco, Italy). Magnetic resonance imaging (MRI) was performed immediately after US. In five patients, PIHI was performed applying a mean mechanical index (MI) of 0.7 +/- 0.1 for a time period of 2.5 min. MRI was started 12 +/- 2 min after US contrast injection. Comparisons of initial and post-US MRI by four blinded readers did not show any signs of BBB disruption. It is concluded that standard contrast-enhanced US perfusion imaging in patients with SVD did not lead to MRI-detectable BBB changes. This gives further evidence for safety of diagnostic US. Future investigations with larger sample sizes and higher-field MRI might give further insights into potential bioeffects of diagnostic, as well as therapeutic, contrast-enhanced transcranial US.
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Wilhelm-Schwenkmezger T, Pittermann P, Zajonz K, Kempski O, Dieterich M, Nedelmann M. Therapeutic application of 20-kHz transcranial ultrasound in an embolic middle cerebral artery occlusion model in rats: safety concerns. Stroke 2007; 38:1031-5. [PMID: 17272763 DOI: 10.1161/01.str.0000257966.32242.0b] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND AND PURPOSE Therapeutic application of diagnostic ultrasound has been shown to improve recanalization rates in patients with acute cerebral vessel occlusion. There is experimental evidence that low-frequency ultrasound may be superior. This study was designed to evaluate the therapeutic efficacy and safety of low-frequency ultrasound in an embolic middle cerebral artery occlusion model in rats. A parameter setting was used that had not previously shown any side effects and interactions with healthy rat brain tissue. METHODS Male Wistar rats were submitted to middle cerebral artery clot embolism and transcranial treatment with 20-kHz continuous-wave ultrasound (0.2 W/cm(2)), either alone or in combination with recombinant tissue-type plasminogen activator. Control groups received no treatment or recombinant tissue-type plasminogen activator alone. Outcome assessment consisted of determination of infarct volume and neurological evaluation. RESULTS Eleven animals treated with ultrasound died during the follow-up period of 7 days, compared with 2 animals in the control groups (P=0.028). In 3 animals, subarachnoid hemorrhage was detected (1 in the control group). The other animals that died displayed secondary worsening after an initial period of normal vigilance. Histological examination revealed massive edema formation. In surviving animals, no benefit of treatment could be demonstrated. CONCLUSIONS In this study, 20-kHz continuous-wave ultrasound caused death in a significant number of animals. Ultrasound at 20 kHz does not seem to be suitable for transcranial therapeutic cerebral application. The data underline the necessity to obtain further animal data to establish the safety limits of frequency and power output.
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Reinhard M, Els T, Hetzel A. Response to Letter by Gerriets et al. Stroke 2007. [DOI: 10.1161/01.str.0000254443.78965.10] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
| | - Thomas Els
- Department of Neurology, University of Freiburg, Freiburg, Germany, Department of Neurology, Marien Hospital Bergisch Gladbach, Bergisch Gladbach, Germany
| | - Andreas Hetzel
- Department of Neurology, University of Freiburg, Freiburg, Germany
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Yamashita A, Kunimatsu T, Yamamoto T, Yoshida KI. Hypothermic, but not normothermic, ischemia causes a drastic increase in cyclooxygenase-2 immunoreactive granule cells in rat dentate gyrus after 4 hours of ischemic reperfusion. ACTA ACUST UNITED AC 2007; 70:197-205. [DOI: 10.1679/aohc.70.197] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Affiliation(s)
- Anzu Yamashita
- Division of Anesthesiology, Department of Clinical Care Medicine, Kanagawa Dental College
| | - Teruhito Kunimatsu
- Division of Anesthesiology, Department of Clinical Care Medicine, Kanagawa Dental College
| | - Toshiharu Yamamoto
- Department of Human Biology, Kanagawa Dental College
- Research Center of Brain and Oral Science, Kanagawa Dental College
| | - Kazu-ichi Yoshida
- Division of Anesthesiology, Department of Clinical Care Medicine, Kanagawa Dental College
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