Properties, characteristics and applications of microbubbles for sonothrombolysis

Introduction: Ultrasound enhancement of thrombolysis(sonothrombolysis) is further potentiated by administration of acoustically active microbubbles, which may be developed into powerful adjuvant therapiesfor thrombolytic treatment of occlusive conditions such as ischaemic stroke. Areas covered: The role of microbubblesin sonothrombolysis is evaluated based on published in vitro and in vivo evidence and a critical review of clinical trials to date. Microbubble, ultrasound and drug parameters compiled from a broad search of the existing literature are tabulated. Mechanisms of microbubble-enhanced sonothrombolysis are discussed, with particular focus on acoustic cavitation and thermal effects. A number of challenges to widespread clinical adoption are identified. Key factors for future optimisation of treatment and microbubbledesign are proposed. Expert opinion: Microbubbleenhancement of thrombolysisis supported by a broad range of in vitro and in vivo evidence that demonstrates improved lysis compared...