Advances in neurosonology – Brain perfusion, sonothrombolysis and CNS drug delivery

Advances in microbubble pharmacology together with novel ultrasound technologies are leading to new emerging applications for both assessment and treatment of stroke patients. Ultrasound perfusion imaging, for example, has added new perspectives for diagnosis and monitoring of both ischemic and hemorrhagic stroke. Real-time brain perfusion imaging of cerebral infarctions is now possible and quantitative algorithms for evaluation of regional cerebral blood flow are being applied for the first time in humans. There is growing interest in therapeutic applications of ultrasound, particularly in the field of sonothrombolysis. Recent results indicate that ultrasound and microbubbles may be effective in clot lysis of ischemic stroke even without additional thrombolytic drugs. Moreover, this combination may be effective in treating the microcirculation, which will give new dimensions to the application of sonothrombolysis in stroke patients. Further therapeutic avenues include opening of the blood–brain barrier (BBB) with ultrasound and microbubbles to enable novel drug delivery to the brain.