The present disclosure describes a therapeutic ultrasound system configured to adaptively transmit ultrasound pulses toward microbubbles in a treatment region to remove an occlusion. In some examples, the system may include a treatment pulse unit configured to transmit an ultrasound pulse to a treatment region of a subject, the treatment region including a plurality of microbubbles. An echo detection unit may be configured to receive one or more echoes responsive to the ultra sound pulse. In some examples, the system may also include a data processor configured to identify, using data associated with the echoes, at least one echo signature indicative of a dynamic state of the microbubbles in response to the ultrasound pulse. A controller may be configured to adjust one or more parameters of an additional ultrasound pulse transmitted to the treatment region via the treatment pulse unit based on the at least one echo signature.