Hematoma Management

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Focused Ultrasound Therapy

Focused ultrasound is a rapidly evolving, noninvasive, therapeutic technology with the potential to improve the quality of life and decrease the cost of care for patients with extravascular hematomas. This novel technology focuses beams of ultrasound energy precisely and accurately on targets deep in the brain without damaging surrounding normal tissue.

How it Works
Where the beams converge, the focused ultrasound produces histotripsy (mechanical destruction) of the fibers within the hematoma. This enables the hematoma to be aspirated with fine needle instead of requiring a surgical removal. While early results are promising, there is still much to be done before this technology will be widely available.

The primary options for treatment of hematomas include medication and invasive surgery.

For certain patients, focused ultrasound could provide a noninvasive alternative to surgery with less risk of complications – such as surgical wound healing or infection – at a lower cost. Focused ultrasound can also reach the desired target without damaging surrounding tissue, and it can be repeated, if necessary.

Clinical Trials

At the present time, there are no clinical trials recruiting patients for focused ultrasound treatment of extravascular hematomas.

Regulatory Approval and Reimbursement

Focused ultrasound treatment for extravascular hematomas is not yet approved by regulatory bodies or covered by medical insurance companies.

Notable Papers

Yang MY, Tu YF, Feng KK, Yin MD, Fang YF, Le JQ, Luo BY, Tan XR, Shao JW. A erythrocyte-platelet hybrid membrane coated biomimetic nanosystem based on ginsenosides and PFH combined with ultrasound for targeted delivery in thrombus therapy. Colloids Surf B Biointerfaces. 2023 Jul 18;229:113468. doi: 10.1016/j.colsurfb.2023.113468. PMID: 37515961 

Bautista KJB, Kim J, Xu Z, Jiang X, Dayton PA. Current Status of Sub-micron Cavitation-Enhancing Agents for Sonothrombolysis. Ultrasound Med Biol. 2023 May;49(5):1049-1057. doi: 10.1016/j.ultrasmedbio.2023.01.018. Epub 2023 Mar 1. PMID: 36868959 

Heo J, Park JH, Kim HJ, Pahk K, Pahk KJ. Sonothrombolysis with an acoustic net-assisted boiling histotripsy: A proof-of-concept study. Ultrason Sonochem. 2023 Jun;96:106435. doi: 10.1016/j.ultsonch.2023.106435. Epub 2023 May 8. PMID: 37178667 

Yuan Y, He X, Liu P, Pu D, Shi Q, Chen J, Teichmann AT, Zhan P. The effectiveness of single ultrasound-guided high-intensity focused ultrasound (USgHIFU) ablation in managing placenta accreta spectrum (PAS) disorder. Arch Gynecol Obstet. 2022 Dec 16. doi: 10.1007/s00404-022-06840-6.

Fang N, Liu J, Hou J, Zhong Y, Luo Y, Hu L, Zhang W, Wang J, Xu J, Zhou J, Zhang Y, Ran H, Guo D. Magnet-Guided Bionic System with LIFU Responsiveness and Natural Thrombus Tropism for Enhanced Thrombus-Targeting Ability. Int J Nanomedicine. 2022 May 4;17:2019-2039. doi: 10.2147/IJN.S357050. eCollection 2022.

Ponomarchuk EM, Rosnitskiy PB, Khokhlova TD, Buravkov SV, Tsysar SA, Karzova MM, Tumanova KD, Kunturova AV, Wang YN, Sapozhnikov OA, Trakhtman PE, Starostin NN, Khokhlova VA. Ultrastructural Analysis of Volumetric Histotripsy Bio-effects in Large Human Hematomas. Ultrasound Med Biol. 2021 Jun 8:S0301-5629(21)00213-1. doi: 10.1016/j.ultrasmedbio.2021.05.002.

Jo J, Forrest ML, Yang X. Ultrasound-assisted laser thrombolysis with endovascular laser and high-intensity focused ultrasound. Med Phys. 2020 Dec 5. doi: 10.1002/mp.14636.

Jiang N, Hu B, Cao S, Gao S, Cao Q, Chen J, Zhou Q, Guo R. Stable Low-Dose Oxygen Release Using H(2)O(2)/Perfluoropentane Phase-Change Nanoparticles with Low-Intensity Focused Ultrasound for Coronary Thrombolysis. Ultrasound Med Biol. 2020 Jul 6:S0301-5629(20)30257-X. doi: 10.1016/j.ultrasmedbio.2020.06.004.

Hendley S, Bollen V, Anthony GJ, Paul JD, Bader KB. In vitro assessment of stiffness-dependent histotripsy bubble cloud activity in gel phantoms and blood clots. Phys Med Biol. 2019 May 30. doi: 10.1088/1361-6560/ab25a6.

Gerhardson T, Sukovich JR, Chaudhary N, Chenevert TL, Ives K, Hall TL, Camelo-Piragua S, Xu Z, Pandey AS. Histotripsy Clot Liquefaction in a Porcine Intracerebral Hemorrhage Model. Neurosurgery. 2019 Mar 29. pii: nyz089. doi: 10.1093/neuros/nyz089.

Boiling histotripsy liquefaction of large extravascular hematomas: in vitro optimization and device design considerations. Presentation by Tanya Khokhlova. 2018

Gerhardson T, Sukovich JR, Pandey AS, Hall TL, Cain CA, Xu Z. Effect of Frequency and Focal Spacing on Transcranial Histotripsy Clot Liquefaction, Using Electronic Focal Steering. Ultrasound Med Biol. 2017 Oct;43(10):2302-2317. doi: 10.1016/j.ultrasmedbio.2017.06.010. Epub 2017 Jul 14.

Khokhlova TD, Monsky WL, Haider YA, Maxwell AD, Wang YN, Matula TJ. Histotripsy Liquefaction of Large Hematomas. Ultrasound Med Biol. 2016 Jul;42(7):1491-8. doi: 10.1016/j.ultrasmedbio.2016.01.020. Epub 2016 Apr 25.

Maxwell AD, Cain CA, Duryea AP, Yuan L, Gurm HS, Xu Z. Noninvasive thrombolysis using pulsed ultrasound cavitation therapy – histotripsy. Ultrasound Med Biol. 2009 Dec;35(12):1982-94. doi: 10.1016/j.ultrasmedbio.2009.07.001. Epub 2009 Oct 24.

Click here for additional references from PubMed.

Early Stage