title: Advancements in catheter-directed ultrasound-accelerated thrombolysis.
abstract: OBJECTIVE
  To review all available literature on catheter-directed ultrasound-accelerated thrombolysis for peripheral artery occlusions, stroke, deep venous thrombosis, and pulmonary embolism.
  
  
  METHODS
  A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. A total of 77 reports focusing on catheter-delivered ultrasound-accelerated thrombolysis were identified.
  
  
  RESULTS
  Experimental studies show that high intensity ultrasound may induce thrombolysis, with and without the addition of plasminogen activators, mainly by acoustic cavitation and mechanical disruption, while low intensity, high frequency ultrasound waves may actually enhance plasmin-mediated thrombolysis. In a total of 340 clinical cases of various thromboembolic conditions, catheter-directed ultrasound-accelerated thrombolysis was related to rapid revascularization and a reduction in treatment time, drug dosage, hospitalization time, and possibly major bleeding complications compared to standard thrombolysis. Reported complication rates, including bleeding and embolization, were low.
  
  
  CONCLUSIONS
  Ultrasound enhanced thrombolysis seems to be a promising concept in the treatment of various thromboembolic conditions. The technique has shown to be safe and efficacious in vitro, in vivo, and in clinical studies. Randomized controlled trials are warranted and should be awaited before considering catheter-directed ultrasound-accelerated thrombolysis as a new standard treatment.
authors.affiliation: Department of Surgery, Rijnstate Hospital, Arnhem, The Netherlands.
authors.forename: Denise E
authors.initials: DE
authors.lastname: Doomernik
authors.forename: A Marjolein
authors.initials: AM
authors.lastname: Schrijver
authors.forename: Clark J
authors.initials: CJ
authors.lastname: Zeebregts
authors.forename: Jean-Paul P M
authors.initials: JP
authors.lastname: de Vries
authors.forename: Michel M P J
authors.initials: MM
authors.lastname: Reijnen
mesh_terms: D000818:Animals; D002318:Cardiovascular Diseases / Q000628:therapy*; D002404:Catheterization / Q000009:adverse effects / Q000295:instrumentation; D057785:Catheters; D005343:Fibrinolytic Agents / Q000008:administration & dosage*; D006801:Humans; D015912:Thrombolytic Therapy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000009:adverse effects / Q000295:instrumentation
chemical_list: D005343:Fibrinolytic Agents