Systematic Analysis of Combined Thrombolysis Using Ultrasound and Different Fibrinolytic Drugs in an in Vitro Clot Model of Intracerebral Hemorrhage

Ultrasound Med Biol. 2021 May;47(5):1334-1342. doi: 10.1016/j.ultrasmedbio.2021.01.005. Epub 2021 Feb 3.


Adequate removal of blood clots by minimally invasive surgery seems to correlate with a better clinical outcome in patients with intracerebral hemorrhages (ICHs). Moreover, neurotoxic effects of recombinant tissue plasminogen activator have been reported. The aim of this study was to improve fibrinolysis using an intra-clot ultrasound application with tenecteplase and urokinase in our established ICH clot model. One hundred thirty clots were produced from 25 or 50 mL of human blood, incubated for different periods and equipped with drainage, through which an ultrasound catheter was placed in 65 treatment clots for 1 h, randomly allocated into three groups: administration of ultrasound, administration of 60 IU of tenecteplase or administration of 30,000 IU urokinase. Relative end weights were compared. This study found a significant increase in thrombolysis caused by a combination of ultrasound and fibrinolytic drugs, whereas ultrasound and tenecteplase are significantly more effective in the treatment of larger and aged clots.

Keywords: Fibrinolytic drugs; In vitro clot model; Intracerebral hemorrhage; Minimally invasive therapy; Ultrasound thrombolysis.

MeSH terms

  • Cerebral Hemorrhage / therapy*
  • Combined Modality Therapy
  • Fibrinolytic Agents / therapeutic use*
  • Humans
  • In Vitro Techniques
  • Mechanical Thrombolysis / methods*
  • Tenecteplase / therapeutic use*
  • Thrombolytic Therapy*
  • Thrombosis / therapy*
  • Ultrasonic Therapy*
  • Urokinase-Type Plasminogen Activator / therapeutic use*


  • Fibrinolytic Agents
  • Urokinase-Type Plasminogen Activator
  • Tenecteplase