Histotripsy: A novel non-invasive ultrasound technology for precision thrombolysis in acute ischemic stroke management

BackgroundStroke remains a major cause of morbidity and mortality worldwide. Traditional treatments for ischemic stroke such as mechanical thrombectomy and pharmacological thrombolysis are often less effective or inaccessible for certain patient populations, particularly those with delayed hospital arrival, contraindications to thrombolytics, or in regions with limited access to endovascular care. This study investigates the feasibility of using histotripsy, a non-invasive ultrasound technology, to precisely liquefy thrombi in an artificial experimental setup.MethodsClot analogs were introduced into sample tubes, and focused ultrasound was applied using optimized parameters, including pulses per burst, repetition rates, and output amplitudes. These parameters were systematically adjusted to determine the most effective settings for clot ablation, with a focus on maximizing clot liquefaction while minimizing residual fragments.ResultsHistotripsy achieved complete clot liquefaction within 60-120 s at a repetition rate of 100 Hz, with 1000 pulses per burst and an output amplitude of 100%. The procedure effectively disintegrated soft (red blood cell-rich) clots, leaving minimal residual fragments (< 250 microns). However, dense fibrin-rich clots and anatomical barriers like bone presented challenges, suggesting the need for further optimization.ConclusionsThis proof-of-concept study demonstrates the potential of histotripsy as a non-invasive, rapid, and targeted approach for clot removal in stroke management.