Low power ultrasound delivered through a PTCA-like guidewire: preclinical feasibility and safety of a novel technology for intracoronary thrombolysis.
BACKGROUND
Low power ultrasound delivered through an angioplasty-like guidewire may be effective for intracoronary thrombolysis. We evaluated the preclinical feasibility and safety of such wire.


RESULTS
In 15 anesthetized Yucatan minipigs, the ultrasonic wire was advanced percutaneously into all three coronaries. Each coronary was randomized to long activation (6 minutes), short activation (3 minutes), or control (3 minutes indwelling, no activation). The energy delivered was 0.14 +/- 0.01 W/cm of active length (20 kHz). No changes in heart rate, rhythm, or arterial pressure occurred during wire positioning or activation. Mean lumen diameter (MLD) by quantitative angiography was not significantly different pre- and postintervention (2.36 +/- 0.12 mm vs 2.36 +/- 0.11 mm for long activation, P = 0.96; 2.33 +/- 0.15 mm vs 2.34 +/- 0.14 mm for short activation, P = 0.54; 2.30 +/- 0.12 mm vs 2.33 +/- 0.12 mm for control, P = 0.21). There were no angiographic stenoses at 60 or 90 days follow-up. Compared with baseline, MLD at follow-up increased in all the three groups (2.40 +/- 0.13 mm vs 2.53 +/- 0.11 mm, P = 0.004 for long activation; 2.37 +/- 0.17 mm vs 2.52 +/- 0.14 mm, P = 0.023 for short activation; 2.20 +/- 0.12 mm vs 2.33 +/- 0.11 mm, P = 0.001 for the control group). By histology, there were no clinically significant pathologic changes in coronary morphology.


CONCLUSIONS
Use of a transverse cavitation therapeutic wire is feasible and well tolerated acutely in the normal porcine coronary. At 60 and 90 days, no angiographically apparent damage, no clinically significant pathologic changes, and no adverse events were seen. This technology may be safely used during percutaneous coronary intervention. Further studies are justified to evaluate its efficacy for intracoronary thrombus ablation.
Division of Cardiology, Center for Translational Cardiovascular Research, Tufts-New England Medical Center, Boston, Massachusetts, USA.
Sung W
SW
Choi
Adam J
AJ
Saltzman
Alexandra
A
Dabreo
Robert N
RN
Salomon
Jonathan G
JG
Gray
Heather
H
Senseney-Mellor
Mark R
MR
Gosnell
Sergio
S
Waxman
D015906:Angioplasty, Balloon, Coronary / Q000295:instrumentation*; D000818:Animals; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000628:therapy*; D003328:Coronary Thrombosis / Q000628:therapy*; D005240:Feasibility Studies; D005260:Female; D008297:Male; D013552:Swine; D015912:Thrombolytic Therapy / Q000295:instrumentation*; D014463:Ultrasonography / Q000295:instrumentation*