Percutaneous Transluminal Therapy of Occluded Saphenous Vein Grafts

Rosenschein, Uri; Gaul, G; Erbel, Raimund; Amann, Franz W.; Velasguez, Diego; Stoerger, H.; Simon, R.; Gomez, German; Tröster, J.; Bartorelli, Antonio L.; Pieper, Michael; Kyriakides, Zenon S.; Laniado, Shlomo; Miller, Hylton I.; Cribier, Alain; Fajadet, Jean

doi:10.1161/01.cir.99.1.26

Cited by 85 publications

(35 citation statements)

References 12 publications

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“…The use of these agents, however, enhances the activity of acoustic cavitation, which can damage tissue and so might limit the clinical application of this technique [8]. Ultrasound energy delivered from an external ultrasound source through a vibrating wire probe has been investigated in vitro [3,4], in canine models [5] and in clinical trials [6] with resultant increased thrombolysis. These methods carry the risks of an invasive endovascular procedure, including vessel rupture, and may not provide substantial benefit over other available invasive endovascular interventions [29].…”

Section: Discussionmentioning

confidence: 99%

“…However, the ultrasound technology employed for directly inducing thrombolysis has involved procedures that are either invasive (e.g. via catheter based techniques) [3][4][5][6] or rely on ultrasound mechanisms such acoustic cavitation [7], which is potentially damaging to surrounding tissues [8]. Ultrasound has also been combined with thrombolytic agents in in vitro and in vivo models with improved rates of thrombolysis [1].…”

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confidence: 99%

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Pulsed-high intensity focused ultrasound enhanced tPA mediated thrombolysis in a novel in vivo clot model, a pilot study

Frenkel

Dromi

et al. 2007

Thrombosis Research

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Introduction-Thrombotic disease continues to account for significant morbidity and mortality. Ultrasound energy has been investigated as a potential primary and adjunctive treatment for thrombotic disease. We have previously shown that pulsed-high intensity focused ultrasound (HIFU) enhances thrombolysis induced by tissue plasminogen activator (tPA) in vitro, including describing the non-destructive mechanism by which tPA availability and consequent activity is increased. In this study we aimed to determined if the same effects could be achieved in vivo.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Pulsed-high intensity focused ultrasound enhanced tPA mediated thrombolysis in a novel in vivo clot model, a pilot study

Frenkel

Dromi

et al. 2007

Thrombosis Research

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“…Furthermore, USE at the site of angioplasty may also arrest VSMC proliferation in response to vascular injury without hindering endothelial regeneration. The proven safety and practicality 16 of intravascular therapeutic ultrasound make this possibility particularly attractive in contrast to lingering concerns over alternative adjunctive technologies such as intracoronary brachytherapy 17 and adenoviral or retroviral gene therapy. 1 Figure 2.…”

Section: Discussionmentioning

confidence: 99%

Ultrasound Enhances Reporter Gene Expression After Transfection of Vascular Cells In Vitro

et al. 1999

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Background-Restenosis after percutaneous coronary intervention remains a serious clinical problem. Progress in local gene therapy to prevent restenosis has been hindered by concerns over the safety and efficacy of viral vectors and the limited efficiency of nonviral techniques. This study investigates the use of adjunctive ultrasound to enhance nonviral gene delivery. Methods and Results-Cultured porcine vascular smooth muscle cells (VSMCs) and endothelial cells (ECs) were transfected with naked or liposome-complexed luciferase reporter plasmid for 3 hours. Ultrasound exposure (USE) for 60 seconds at 1 MHz, 0.4 W/cm 2 , 30 minutes into this transfection period enhanced luciferase activity 48 hours later by 7.5-fold and 2.4-fold, respectively. Luciferase activity after lipofection of ECs was similarly enhanced 3.3-fold by adjunctive USE. USE had no effect on cell viability, although it inhibited VSMC but not EC proliferation. An alternative strategy is single-dose local administration of agents that can modify the vascular response to injury, including local gene therapy. 1 Viral vectors achieve the highest efficiency, but substantial concerns remain over their clinical safety and long-term efficacy. 1 Although relatively safe, nonviral gene delivery, including lipofection, is currently at least 10-fold less efficient. 1 Ultrasound exposure (USE) has been shown to permeabilize plasma membranes and reduce the thickness of the unstirred layer at the cell surface, 2,3 which should encourage DNA entry into cells. Furthermore, many lipofection reagents contain dioleoylphosphatidylethanolamine (DOPE), which encourages DNA "breakout" from endosomes through a physicochemical transition that is known to be accelerated by USE. 4,5 On the basis of these observations, we investigated the hypothesis that USE may enhance transgene expression after naked DNA and/or liposome-mediated transfection of primary vascular cells. Conclusions-Adjunctive Methods Cell Culture and Transfection ConditionsPorcine medial vascular smooth muscle cells (VSMCs) and lumenal endothelial cells (ECs) from the thoracic aorta of Yorkshire White cross pigs aged Ͻ6 months were cultured in DMEM containing 10% porcine serum; EC cultures were supplemented with EC growth factor (20 g/mL; Sigma) and heparin (90 g/mL; Sigma). All transfections were performed for 3 hours at 37°C in 24-well plates with cells at 60% to 70% confluence and were stopped by dilution with 1 mL of fresh culture medium. Naked DNA transfections were performed in 200 L of DMEM containing 10% porcine serum and 7.5 g/mL luciferase plasmid DNA (pGL3; Promega) per well. Lipofections used Promega Tfx-50 (which contains DOPE), according to conditions optimized for VSMCs (200 L of DMEM containing 10% porcine serum; DNA:lipid charge ratio of 4:1; 7.5 g/mL final DNA concentration) and ECs (200 L of serum-free DMEM; DNA:lipid charge ratio 3:1; 5 g/mL final DNA concentration).Thirty minutes after the transfection was begun, USE was performed for 60 seconds with a custom-built, 10-mm-diameter, 1-MHz ...

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“…In some reports, thrombi were mechanically disrupted in vitro 22,23 or in animal models 23,24 with wires vibrating at US frequencies in the absence of plasminogen activator, and this approach has been tested in small studies in patients with coronary 25 or peripheral 26,27 arterial occlusion and with occluded coronary bypass grafts. 28 This treatment requires endovascular positioning of the wire, and it can result in vessel wall damage, excessive heating, and distal embolization of clot fragments. Externally applied highintensity US alone without plasminogen activator at 20 kHz has been used to recanalize femoral artery thrombi in a rabbit model, but excessive heating also occurred.…”

Section: Suchkova Et Al Ultrasound Increases Thrombolysis and Perfusionmentioning

confidence: 99%

Effect of 40-kHz Ultrasound on Acute Thrombotic Ischemia in a Rabbit Femoral Artery Thrombosis Model

2000

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Background —We have shown previously that 40-kHz ultrasound (US) at low intensity accelerates fibrinolysis in vitro with little heating and good tissue penetration. These studies have now been extended to examine the effects of 40-kHz US on thrombolysis and tissue perfusion in a rabbit model. Methods and Results —Treatment was administered with either US alone at 0.75 W/cm 2 , streptokinase alone, or the combination of US and streptokinase. US or streptokinase resulted in minimal thrombolysis, but reperfusion was nearly complete with the combination after 120 minutes. US also reversed the ischemia in nonperfused muscle in the absence of arterial flow. Tissue perfusion decreased after thrombosis from 13.7±0.2 to 6.6±0.8 U and then declined further to 4.5±0.4 U after 240 minutes. US improved perfusion to 10.6±0.5 and 12.1±0.5 U after 30 and 60 minutes, respectively. This effect was reversible and declined to pretreatment values after US was discontinued. Similarly, tissue pH declined from normal to 7.05±0.02 after thrombosis, but US improved pH to 7.34±0.03 after 60 minutes. US-induced improvement in tissue perfusion and pH also occurred after femoral artery ligation, indicating that thrombolysis did not cause these effects. Conclusions —40-kHz US at low intensity markedly accelerates fibrinolysis and also improves tissue perfusion and reverses acidosis, effects that would be beneficial in treatment of acute thrombosis.

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Percutaneous Transluminal Therapy of Occluded Saphenous Vein Grafts

Abstract: Ultrasound thrombolysis in thrombus-rich lesions in SVGs offers a very promising therapeutic option.

Cited by 85 publications

References 12 publications

Pulsed-high intensity focused ultrasound enhanced tPA mediated thrombolysis in a novel in vivo clot model, a pilot study

Pulsed-high intensity focused ultrasound enhanced tPA mediated thrombolysis in a novel in vivo clot model, a pilot study

Ultrasound Enhances Reporter Gene Expression After Transfection of Vascular Cells In Vitro

Effect of 40-kHz Ultrasound on Acute Thrombotic Ischemia in a Rabbit Femoral Artery Thrombosis Model

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