Department of Neurology, University of New Mexico Hospitals, Albuquerque, NM.
California Institute of Neuroscience, Thousand Oaks, CA.
J Neuroimaging. 2019 Jan;29(1):5-13. doi: 10.1111/jon.12568. Epub 2018 Oct 8.
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.
中风，无论是缺血性还是出血性，在全球范围内都导致了极高的发病率和死亡率，每年影响数百万人的生命。在过去的几十年中，超声已被广泛研究用于促进血栓溶解，以治疗中风、心肌梗死和急性外周动脉闭塞，无论是否使用 tPA 或对比剂。在现代微创技术时代，磁共振成像引导高强度聚焦超声是一种新出现的模式，似乎为缺血性和出血性中风提供了治疗效用。高强度聚焦超声会引起热加热，因为组织吸收了超声波传递的机械能，导致组织变性和凝固。几项体外和体内研究已经证明了这项技术在两种类型的中风中进行超声溶栓的可行性，并进行了临床试验。除了安全性和有效性之外，启动试验还将进一步回答其在临床设置中的实际应用问题。尽管这项技术已经研究了几十年，用于治疗各种脑部疾病，但似乎很少有神经科医生甚至神经外科医生熟悉它。本文的目的是提供对这项强大技术的基本了解，并讨论其临床应用和作为未来中风管理的新兴可行治疗选择的潜在作用。
