Emerging Thrombolysis Technologies in Vascular Thrombosis

Abstract

Background/Objectives: Thrombotic diseases, such as ischemic stroke, acute myocardial infarction, and venous thromboembolism, are leading causes of global morbidity and mortality. Traditional thrombolytic therapies like systemic tissue plasminogen activator (tPA) are limited by bleeding risks, poor targeting, and inconsistent efficacy. This review explores emerging non-pharmacological technologies aimed at overcoming these challenges through targeted, minimally invasive thrombolysis. Methods: A narrative synthesis of recent advancements was conducted, focusing on six innovative approaches: ultrasound-mediated thrombolysis (UMT), microrobots, electrothrombectomy, photothrombectomy, magnetic targeted thrombolysis, and nanotechnology. Preclinical and clinical studies were reviewed to assess mechanisms, efficacy, safety, and translational potential, prioritizing technologies with demonstrated success in animal or early human trials. Results: Technologies like microbubble-enhanced UMT, magnetically actuated microrobots, and fibrin-targeted nanoparticles showed promising results. UMT improved recanalization in ischemic stroke and pulmonary embolism, while electrothrombectomy demonstrated safe, effective clot extraction in human trials. However, challenges remain in scalability, biocompatibility, and clinical integration, with microrobots and photothrombectomy still in preclinical stages. Conclusions: Emerging thrombolysis technologies offer safer, more targeted alternatives to conventional treatments. Clinical adoption will depend on overcoming translational hurdles, including large-scale trials, miniaturization, and interdisciplinary collaboration, with a focus on hybrid approaches and real-time imaging integration.

Keywords: electromechanical; magnetic; microbots; nanoparticles; phototherapy; thrombolysis; thrombosis; ultrasound.

Figure 1

Schematic representation of emerging non-pharmacological thrombolysis strategies. Sonothrombolysis uses ultrasound-induced cavitation to enhance clot dissolution. Magnetic-directed thrombolysis employs iron oxide nanoparticles guided by external magnetic fields. Photo- and electrothrombectomy involve light-based or electrical energy to ablate or extract thrombi. Microrobots navigate vasculature to mechanically disrupt clots, while nanoparticles enable targeted delivery and controlled release of thrombolytic agents. Abbreviation: tPA, tissue plasminogen activator.

Figure 2

Conceptual design of a nanoparticle-based thrombolytic agent combining (a) a nanocarrier platform with (b) a thrombolytic payload, (c) targeting or imaging ligands, and (d) additional therapeutic compounds. Such multi-functional nanomedicines aim to prolong drug half-life, increase clot penetration, enable precise delivery (potentially with mechanical triggers), and concurrently address secondary injury.

Figure 3

Existing nanotechnologies and potential translational benefits for thrombolysis. DNA (deoxyribonucleic acid).