Coronary Ultrasound Thrombolysis: From Acute Myocardial Infarction to Saphenous Vein Grafts and Beyond.
During high-power ultrasound irradiation in fluids, microbubbles are formed and collapse to generate shock waves and induce fibrinolysis. In vivo, intracoronary injection of ultrasound-lysed clots increased myocardial perfusion. The experience with the ultrasound thrombolysis catheter in the ACUTE (Analysis of Coronary Ultrasound Thrombolysis Endpoints) trial showed that primary percutaneous coronary ultrasound thrombolysis (PCUT) in patients with anterior acute myocardial infarction and occluded left anterior descending artery was very successful in inducing safe and effective reperfusion and excellent myocardial salvage. The left ventricular ejection fraction at 6-month follow-up increased by 29% (P = 0.0005). The Acolysis Registry investigated prospectively PCUT in patients with acute coronary syndromes (n = 160) in a multicenter (n = 32) registry. Procedural success was achieved in 124 (98%) patients. In the saphenous vein graft (SVG) subset (n = 34), (78% of the vessels occluded at baseline) PCUT led to successful recanalization (TIMI 2-3) in 75% of the patients (P = 0.0003). Currently, PCUT is being evaluated in a randomized trial (ATLAS ) for the treatment of thrombus-containing coronary SVGs. These data suggest that thrombus debulking prior to percutaneous transluminal coronary intervention by therapeutic ultrasound is a very safe and effective percutaneous coronary intervention strategy. Ultrasound can be used to treat thrombi of a side spectrum of age and size.
Rosenschein
Uri
U
Catheterization Laboratory, Department of Cardiology, Tel Aviv Sourasky Medical Center, 6 Weizman Street, Tel Aviv 64239, Israel. urosenschein@angiosonics.co.il
Brosh
David
D
Halkin
Amir
A