Sonothrombolysis in the ambulance for ST-elevation myocardial infarction: rationale and protocol

Kadi, Soufiane El; Porter, Thomas R.; Rossum, Albert C. van; Kamp, Otto

doi:10.1007/s12471-020-01516-9

Cited by 10 publications

(5 citation statements)

References 47 publications

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“…Furthermore, a substudy showed improved LV global longitudinal strain and decreased perfusion defect size by MCE at follow up, and the only independent predictor of LV remodeling was treatment with sonothrombolysis ( 106 ). As contrast ultrasound is portable, this technique was also shown to have a promising feasibility of in-ambulance sonothrombolysis for STEMI ( 107 ). These findings have provided more insight into the background of sonothrombolysis by contrast ultrasound and additional multi-center prospective studies are needed to test the clinical effectiveness of this method.…”

Section: Applications Of Mce In the Treatment Of Cmdmentioning

confidence: 99%

Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound

Zhan

Zhong²,

Wu³

2022

Front. Cardiovasc. Med.

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With growing evidence in clinical practice, the understanding of coronary syndromes has gradually evolved out of focusing on the well-established link between stenosis of epicardial coronary artery and myocardial ischemia to the structural and functional abnormalities at the level of coronary microcirculation, known as coronary microvascular dysfunction (CMD). CMD encompasses several pathophysiological mechanisms of coronary microcirculation and is considered as an important cause of myocardial ischemia in patients with angina symptoms without obstructive coronary artery disease (CAD). As a result of growing knowledge of the understanding of CMD assessed by multiple non-invasive modalities, CMD has also been found to be involved in other cardiovascular diseases, including primary cardiomyopathies as well as heart failure with preserved ejection fraction (HFpEF). In the past 2 decades, almost all the imaging modalities have been used to non-invasively quantify myocardial blood flow (MBF) and promote a better understanding of CMD. Myocardial contrast echocardiography (MCE) is a breakthrough as a non-invasive technique, which enables assessment of myocardial perfusion and quantification of MBF, exhibiting promising diagnostic performances that were comparable to other non-invasive techniques. With unique advantages over other non-invasive techniques, MCE has gradually developed into a novel modality for assessment of the coronary microvasculature, which may provide novel insights into the pathophysiological role of CMD in different clinical conditions. Moreover, the sonothrombolysis and the application of artificial intelligence (AI) will offer the opportunity to extend the use of contrast ultrasound theragnostics.

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Section: Applications Of Mce In the Treatment Of Cmdmentioning

confidence: 99%

Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound

Zhan

Zhong²,

Wu³

2022

Front. Cardiovasc. Med.

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“…Ultrasound-guided thrombolysis is one of the most specific targeted tactics to improve thrombus dissolution. Previous studies have shown that the addition of sonothrombolysis before and after emergency PCI for acute STEMI can immediately improve microvascular flow (22,23). Microbubble cavitation induced by US has both catalytic and flow-inducing properties, and this approach takes advantage of these properties to create flow.…”

Section: Enhancing the Microcirculation By Using Better Techniquesmentioning

confidence: 99%

“…Intra-ambulance sonothrombolysis for STEMI has shown promising results in the first clinical trial (23), and the delivery of 3D-sono-assisted-thrombolysis in the ambulance may provide a convenient means of achieving rapid reperfusion while also treating microvascular injury and preventing systemic delays in the event of STEMI. The clinical feasibility and efficacy of 3D-sono-assistedthrombolysis in the treatment of STEMI in the clinical context need to be studied further.…”

Section: Prognosis and Future Directionsmentioning

confidence: 99%

Sono-assisted-thrombolysis by three-dimensional diagnostic ultrasound improves epicardial recanalization and microvascular perfusion in acute myocardial infarction

Qiu¹,

Zhong²,

Feng³

et al. 2022

Quant Imaging Med Surg

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Background: This study aimed to evaluate the multiple interactions between therapeutic ultrasound (TUS), microbubbles (MB), and recombinant tissue plasminogen activator (r-tPA) by using three-dimensional (3D) ultrasound to examine the impact of thrombolysis with r-tPA on epicardial recanalization and microcirculation in patients with acute ST-segment-elevation myocardial infarction (STEMI).Methods: Acute thrombotic occlusion of the left anterior descending (LAD) artery was induced in 32 Bama pigs, who were fed a high-cholesterol diet and randomized into four groups: (I) a 3D-sono-assisted-thrombolysis (3D/TUS + MB + r-tPA) group; (II) a 3D/TUS + MB group; (III) a full-dose r-tPA group; and (IV) a 3D/TUS alone group. Epicardial angiographic recanalization rate, microcirculation in the at-risk myocardium, STsegment elevation on electrocardiogram, and changes in the at-risk myocardium and the myocardial infarct area were compared between the groups.Results: After treatment, distal LAD recanalization was observed in 87.5% (7/8) of pigs in the 3D/TUS + MB + r-tPA group, which was significantly higher than the rates observed in the 3D/TUS + MB (37.5%) and the full-dose r-tPA (50.0%) groups (all P<0.05). The average acoustic intensity in the 3D/TUS + MB + r-tPA group (193.78±10.15 dB) was also significantly higher than that in the 3D/TUS + MB (154.29±31.94 dB) and the r-tPA (141.42±28.31 dB) groups (all P<0.05). The decrease in ST-segment elevation in the 3D/TUS + MB + r-tPA group (1.31±1.22 mm) was significantly higher than that in the 3D/TUS + MB (5.38±1.77 mm) and the r-tPA (4.30±2.08 mm) groups (all P<0.05). Furthermore, the ratio of the infarcted myocardial area divided by the at-risk myocardial area was markedly lower in the 3D/TUS + MB + r-tPA group (0.51±0.14) than in the 3D/TUS + MB (0.69±0.28) and r-tPA (0.75±0.23) groups (all P<0.05).Conclusions: Three-dimensional sono-assisted-thrombolysis directly improves infarct-related recanalization rates, enhances microcirculation, reduces r-tPA dosage, and ameliorates the thrombolytic effect of r-tPA in acute STEMI.

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“…With the emergence of this novel treatment, even portable ultrasound is going to be studied for safety and feasibility of sonothrombolysis in the ambulance between STEMI diagnosis and transfer to PCI center [ 33 ].…”

Section: Therapies To Prevent Distal Embolizationmentioning

confidence: 99%

New Interventional Therapies beyond Stenting to Treat ST-Segment Elevation Acute Myocardial Infarction

Vidal-Calés

Cepas‐Guillén

Brugaletta

et al. 2021

JCDD

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Myocardial infarction remains the principal cause of death in Europe. In patients with ST-segment-elevation myocardial infarction (STEMI), a promptly revascularization with primary percutaneous intervention (PCI) has transformed prognosis in the last decades. However, despite increasing successful PCI procedures, mortality has remained unchanged in recent years. Also, due to an unsatisfactory reperfusion, some patients have significant myocardial damage and suffer left ventricular adverse remodeling with reduced function—all that resulting in the onset of heart failure with all its inherent clinical and socioeconomic burden. As a consequence of longer ischemic times, distal thrombotic embolization, ischemia-reperfusion injury and microvascular dysfunction, the resultant myocardial infarct size is the major prognostic determinant in STEMI patients. The improved understanding of all the pathophysiology underlying these events has derived to the development of several novel therapies aiming to reduce infarct size and to improve clinical outcomes in these patients. In this article, based on the mechanisms involved in myocardial infarction prognosis, we review the new interventional strategies beyond stenting that may solve the suboptimal results that STEMI patients still experience.

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Sonothrombolysis in the ambulance for ST-elevation myocardial infarction: rationale and protocol

Cited by 10 publications

References 47 publications

Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound

Assessment and Treatment for Coronary Microvascular Dysfunction by Contrast Enhanced Ultrasound

Sono-assisted-thrombolysis by three-dimensional diagnostic ultrasound improves epicardial recanalization and microvascular perfusion in acute myocardial infarction

New Interventional Therapies beyond Stenting to Treat ST-Segment Elevation Acute Myocardial Infarction

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