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Cardiovascular Sonothrombolysis

  • Echocardiography (JM Gardin and AH Waller, Section Editors)
  • Published:
Current Cardiology Reports Aims and scope Submit manuscript

Abstract

Purpose of Review

This review will provide recent pre-clinical and initial clinical trials exploring the efficacy of sonothrombolysis as an adjunct to current emergent therapies in acute coronary syndromes.

Recent Findings

The initial clinical trials examining the efficacy of short pulse duration diagnostic ultrasound (DUS) high mechanical index impulses in patients with ST segment elevation myocardial infarction (STEMI) have demonstrated that there is improved patency of the infarct vessel, and improved microvascular flow following percutaneous coronary intervention. Subsequent randomized prospective trials have confirmed that in patients with acute STEMI receiving an intravenous microbubble infusion, diagnostic high mechanical index impulses applied in the apical windows pre- and post-percutaneous coronary intervention have reduced myocardial infarction size, as assessed by magnetic resonance imaging at 72 h following presentation, and have been associated with better left ventricular systolic function at 6 month follow-up.

Summary

Sonothrombolysis has potential for improving early epicardial coronary artery patency and reduce left ventricular remodeling when added to current interventional strategies in STEMI.

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Abbreviations

DUS:

Diagnostic ultrasound

FDA:

Food and Drug Administration

IC:

Inertial cavitation

STEMI:

ST segment elevation myocardial infarction

PWD:

Pulsed wave Doppler

PCI:

Percutaneous coronary intervention

MI:

Mechanical index

References

Papers of particular interest, published recently, have been highlighted as: • Of importance •• Of major importance

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Acknowledgments

The authors want to thank Megan Hoesing for her dedicated work in preparing this manuscript and to the Theodore Hubbard Foundation for funding of costs associated with manuscript preparation.

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Authors and Affiliations

  1. Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198, USA

    Thomas R. Porter

  2. Departamento de Cardiopneumologia da Faculdade de Medicina, University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo, 03178-200, Brazil

    Wilson Mathias Jr

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Contributions

TRP has written the entire paper, whereas WM has assisted with manuscript preparation and figures.

Corresponding author

Correspondence to Thomas R. Porter.

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Conflict of Interest

Dr. Porter receives research equipment support from Philips Ultrasound. From Bracco, Dr. Porter receives educational support and he is on their Speaker’s Bureau. Dr. Porter also receives salary and research support from the Theodore F. Hubbard Foundation. In addition, Dr. Porter has a patent issued on Thrombolytic Agents and Methods of Treatment for Thrombosis issued to #6,197,345).

Wilson Mathias Jr. declares that he has no conflict of interest.

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This article does not contain any studies with human or animal subjects performed by any of the authors.

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Porter, T.R., Mathias, W. Cardiovascular Sonothrombolysis. Curr Cardiol Rep 21, 86 (2019). https://doi.org/10.1007/s11886-019-1167-z

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