Therapeutic application of contrast ultrasound in ST elevation myocardial infarction: Role in coronary thrombosis and microvascular obstruction

Abstract

In the past few decades, cardiac ultrasound has become a widely available, easy-to-use diagnostic tool in many scenarios in acute cardiac care. The introduction of microbubbles extended its diagnostic value. Not long thereafter, several investigators explored the therapeutic potential of contrast ultrasound on thrombus dissolution. Despite large improvements in therapeutic options, acute ST elevation myocardial infarction remains one of the main causes of mortality and morbidity in the western world. The therapeutic effect of contrast ultrasound on thrombus dissolution might prove to be a new, effective treatment strategy in this group of patients. With the recent publication of human studies scrutinising the therapeutic options of ultrasound and microbubbles in ST elevation myocardial infarction, we have entered a new stage in this area of research. This therapeutic effect is based on biochemical effects both at macrovascular and microvascular levels, of which the exact working mechanisms remain to be elucidated in full. This review will give an up-to-date summary of our current knowledge of the therapeutic effects of contrast ultrasound and its potential application in the field of ST elevation myocardial infarction, along with its future developments.

Targeted, Site-Specific, Delivery Vehicles of Therapeutics for COVID-19 Patients. Brief Review

“…Another approach is the recently, commercially available intravenous microbubbles, which has been utilized for ultrasound-targeted sono-thrombolysis in acute myocardial infarction and in pulmonary thromboembolic disease. 6 , 7 The mechanism for sono-thrombolysis appears to be cavitation induced thrombus dissolution in addition to vasodilation induced by endothelial shear-release of nitric oxide. 8 …”

“…It should be noted that while there has been substantial research on local drug delivery vehicles in cancer and cardiovascular medicine, broadly; there appear to be only a handful of reports that describes using different carriers for targeted delivery in patients with COVID-19. 6 – 10 In the following, some of the newer approaches for targeted drug delivery in COVID-19 patients are discussed. It may also apply to other bacterial or viral pneumonias not associated with COVID-19.…”

Intraoperative visualisation and treatment of salivary glands in Sjögren’s syndrome by contrast-enhanced ultrasound sialendoscopy (CEUSS): protocol for a phase I single-centre, single-arm, exploratory study

“…These microbubbles, consisting of 5-10 µm gas-filled particles, were initially used as contrast agents to demonstrate occlusions of fluid flow, but are currently also being used in the cardiology field to dissolve arterial occlusions. [12][13][14][15] The proposed mechanism of action is that microbubbles can oscillate under the influence of ultrasound (US).…”

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

“…No or only small beneficial effects in a selected patient population have been demonstrated. Other interventions such as thrombus aspiration to reduce distal embolisation [12] and remote ischaemic [14]. In-vitro studies and in-vivo STEMI models have shown the potential of sonothrombolysis for restoration of epicardial and microvascular flow [15].…”