Analysis of Coronary Ultrasound Thrombolysis Endpoints in Acute Myocardial Infarction (ACUTE Trial)

Rosenschein, Uri; Roth, Arie; Rassin, Tovy A.; Basan, Samuel; Laniado, Shlomo; Miller, Hylton I.

doi:10.1161/01.cir.95.6.1411

Cited by 116 publications

(55 citation statements)

References 18 publications

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“…Catheter-based systems have been used with oscillating wires to cause direct thrombolysis (10)(11)(12). However, these methods are considerably more invasive than externally delivered ultrasound.…”

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confidence: 99%

Pulsed High-Intensity Focused Ultrasound Enhances Thrombolysis in an in Vitro Model

et al. 2006

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Purpose-To evaluate the use of pulsed high-intensity focused ultrasound exposures to improve tissue plasminogen activator (tPA)-mediated thrombolysis in an in vitro model. Materials and Methods-All experimental work was compliant with institutional guidelines andHIPAA. Clots were formed by placing 1 mL of human blood in closed-off sections of pediatric Penrose tubes. Four experimental groups were evaluated: control (nontreated) clots, clots treated with pulsed high-intensity focused ultrasound only, clots treated with tPA only, and clots treated with pulsed high-intensity focused ultrasound plus tPA. The focused ultrasound exposures (real or sham) were followed by incubations of the clots in tPA with saline or in saline only. Thrombolysis was measured as the relative reduction in the mass of the clot. D-Dimer assays also were performed. Two additional experiments were performed and yielded dose-response curves for two exposure parameters: number of pulses per raster point and total acoustic power. Radiation force-induced displacements caused by focused ultrasound exposures were simulated in the clots. A Tukey-Kramer honestly significant difference test was performed for comparisons between all pairs of experimental groups.Results-The clots treated with focused ultrasound alone did not show significant increases in thrombolysis compared with the control clots. The clots treated with focused ultrasound plus tPA showed a 50% ([30.2/20.1]/20.1) increase in the degree of thrombolysis compared with the clots treated with tPA only (P < .001), further corroborating the D-dimer assay results (P < .001). Additional experiments revealed how increasing both the number of pulses per raster point and the total acoustic power yielded corresponding increases in the thrombolysis rate. In the latter experiment, simulations performed at a range of power settings revealed a direct correlation between increased displacement and observed thrombolysis rate.Conclusion-The rate of tPA-mediated thrombolysis can be enhanced by using pulsed highintensity focused ultrasound exposure in vitro.Venous thromboembolism, which includes deep venous thrombosis and pulmonary embolism, accounts for about 250 000 hospitalizations per year in the United States (1). Venous Address correspondence to V.F. (e-mail: vfrenkel@cc.nih.gov For decades patients with venous thrombosis have been treated primarily with anticoagulation, which is usually effective at slowing further thrombus formation. However, anticoagulation is often inadequate for eliminating the source of subsequent emboli, alleviating the hemodynamic disturbances, preventing subsequent valvular damage, and preventing permanent impairment to the pulmonary vascular bed (3). For this reason, more aggressive therapy, such as thrombolysis or thrombectomy, is sometimes used.Ultrasound has been studied as a treatment adjunct to thrombolytic drugs for thrombolysis, as well as an independent treatment method in various models (4-9). Catheter-based systems have been used with oscillating wires to ...

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confidence: 99%

Pulsed High-Intensity Focused Ultrasound Enhances Thrombolysis in an in Vitro Model

et al. 2006

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“…1,2,4,5,9,11,14,26 Catheterbased ultrasound ablation has been used to dissolve clots in patients with acute myocardial infarctions, and externally delivered ultrasound has proved effective for recanalizing thrombosed ileofemoral arteries in rabbits. 26,27 The present study is the first to report that high-intensity ultrasound energy can be focused from outside the beating heart to a desired location within this organ without damage to intervening tissue.…”

Section: Comparison With Transcatheter Ultrasound Ablationmentioning

confidence: 74%

Extracardiac Ablation of the Canine Atrioventricular Junction by Use of High-Intensity Focused Ultrasound

et al. 1999

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Background-High-intensity focused ultrasound has been applied to internal organs from outside the body to ablate tissue.No published study has assessed the feasibility of ablating cardiac tissue within the beating heart by use of this type of therapeutic ultrasound. The purpose of this study was to determine whether high-intensity focused ultrasound can be used to ablate the atrioventricular (AV) junction within the beating heart. Methods and Results-Ten dogs were anesthetized and underwent a thoracotomy. The heart was covered with a polyvinyl chloride membrane. The thorax above the membrane was perfused with degassed water, which functioned as a coupling medium for the ultrasound. A 7.0-MHz diagnostic ultrasound probe was affixed to a spherically focused 1.4-MHz high-intensity focused ultrasound transducer with a 1.1ϫ8.3-mm focal zone 63.5 mm from the ablation transducer. The diagnostic ultrasound probe was calibrated such that the location of the focal zone of the ablation transducer was identifiable on the 2-dimensional ultrasound image. Target sites were identified with the diagnostic ultrasound. The maximum ultrasound intensity for ablation (2.8 kW/cm 2 ) was delivered to the AV junction only during electrical diastole and for a total of 30 seconds. Complete AV block was achieved in each of the 10 dogs with 6.5Ϯ5.6 (range, 3 to 21) 30-second applications of therapeutic ultrasound. Gross inspection showed that the mean lesion volume was 124Ϯ143 mm 3 , with a depth of 6.7Ϯ3.6 mm, a length of 5.7Ϯ2.5 mm, and a width of 4.7Ϯ1.8 mm. Four hours after the dogs were killed, histopathological study demonstrated a well-demarcated area of necrosis and early inflammation. Conclusions-High-intensity focused ultrasound produces well-demarcated lesions and appears to be a feasible energy source to create complete AV block within the beating heart without damaging the overlying or underlying cardiac tissue. This energy source may allow for a noninvasive approach to ablation of cardiac arrhythmias. (Circulation. 1999;100:203-208.)

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“…In the Analysis of Coronary Sonography Thrombolysis Endpoints in Acute Myocardial Infarction study, low-frequency (45 kHz) sonography was used with high intensity (18 W/cm 2 ) in the treatment of acute occlusion of the coronary arteries. 29 Complete recanalization was achieved in 87% of patients. No side effects were observed during therapy, and 80% of patients showed clinical improvement.…”

Section: Discussionmentioning

confidence: 97%

Safety and Efficacy of Endovascular Sonolysis Using the EkoSonic Endovascular System in Patients with Acute Stroke

Kuliha

Roubec

Jonszta

et al. 2013

AJNR Am J Neuroradiol

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Analysis of Coronary Ultrasound Thrombolysis Endpoints in Acute Myocardial Infarction (ACUTE Trial)

Abstract: These results suggest that ultrasound thrombolysis has the potential to be a safe and effective catheter-based therapeutic modality in reperfusion therapy for patients with AMI and other clinical conditions associated with intracoronary thrombosis.

Cited by 116 publications

References 18 publications

Pulsed High-Intensity Focused Ultrasound Enhances Thrombolysis in an in Vitro Model

Pulsed High-Intensity Focused Ultrasound Enhances Thrombolysis in an in Vitro Model

Extracardiac Ablation of the Canine Atrioventricular Junction by Use of High-Intensity Focused Ultrasound

Safety and Efficacy of Endovascular Sonolysis Using the EkoSonic Endovascular System in Patients with Acute Stroke

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