Ultrasonic angioplasty in totally occluded peripheral arteries. Initial clinical, histological, and angiographic results.

Rosenschein, Uri; Rozenszajn, L. A.; Kraus, L; Marboe, Charles C.; Watkins, J.; Rose, Eric A.; David, D. J.; Pj, Cannon; Weinstein, Joseph

doi:10.1161/01.cir.83.6.1976

Cited by 96 publications

(28 citation statements)

References 19 publications

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“…Activation of the wire can disrupt the thrombus within minutes into particles which can either be aspirated or embolized distally. Percutaneous, transvascular ultrasonic disruption of a femoral artery thrombus has been reported in a single patient ( 13), and ultrasound has also been used to recanalize arteries obstructed by atherosclerosis ( 19,20). In general, few complications have been reported in dog models, although heating ofthe catheter may occur ( 13 ).…”

Section: Discussionmentioning

confidence: 99%

Enhancement of fibrinolysis in vitro by ultrasound.

Francis¹,

Onundarson²,

Carstensen³

et al. 1992

J. Clin. Invest.

234

123

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The effect of ultrasound on the rate of fibrinolysis has been investigated using an in vitro system. Plasma or blood clots containing a trace label of 125I fibrin were suspended in plasma containing plasminogen activator and intermittently exposed to continuous wave 1-MHz ultrasound at intensities up to 8 W/ cm2. Plasma clot lysis at 1 h with 1 igg/ml recombinant tissue plasminogen activator (rt-PA) was 12.8±1.2% without ultrasound and was significantly (P = 0.0001) increased by exposure to ultrasound with greater lysis at 1 W/cm2 (18.0 ± 1.4%), 2 W/cm2 (19.3 ± 0.7%), 4 W/cm2 (22.8 ± 1.8%), and 8 W/cm2 (58.7 ± 7.1%). Significant increases in lysis were also seen with urokinase at ultrasound intensities of 2 W/cm2 and above. Exposure of clots to ultrasound in the absence of plasminogen activator did not increase lysis. Ultrasound exposure resulted in a marked reduction in the rt-PA concentration required to achieve an equivalent degree of lysis to that seen without ultrasound. For example, 15% lysis occurred in 1 h at 1 gg/ml rt-PA without ultrasound or with 0.2 ug/ml with ultrasound, a fivefold reduction in concentration. Ultrasound at 1 W/cm2 and above also potentiated lysis of retracted whole blood clots mediated by rt-PA or urokinase. The maximum temperature increase of plasma clots exposed to 4 W/cm2 ultrasound was only 1.7°C, which could not explain the enhancement offibrinolysis. Ultrasound exposure did not cause mechanical fragmentation of the clot into sedimentable fragments, nor did it alter the sizes of plasmic derivatives as demonstrated by SDS polyacrylamide gel electrophoresis. We conclude that ultrasound at 1 MHz potentiates enzymatic fibrinolysis by a nonthermal mechanism at energies that can potentially be applied and tolerated in vivo to accelerate therapeutic fibrinolysis. (J.

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Section: Discussionmentioning

confidence: 99%

Enhancement of fibrinolysis in vitro by ultrasound.

Francis¹,

Onundarson²,

Carstensen³

et al. 1992

J. Clin. Invest.

234

123

View full text Add to dashboard Cite

show abstract

“…12,16,36 It is generally accepted that clot lysis depends on inertial cavitation, where microbubbles expand rapidly and collapse violently with the resultant mechanical force causing clot lysis. 15,24,[45][46][47][48] Lower-frequency systems (230-kHz ExAblate transducer) can use cavitation for treatment effect while mid-frequency (650-kHz) or high-frequency (1-MHz) systems are more ideal for creating a precise thermal lesion with the avoidance of cavitation.…”

Section: Sonothrombolysismentioning

confidence: 99%

Potential intracranial applications of magnetic resonance–guided focused ultrasound surgery

Monteith¹,

Sheehan²,

Medel³

et al. 2013

JNS

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Magnetic resonance-guided focused ultrasound surgery (MRgFUS) has the potential to create a shift in the treatment paradigm of several intracranial disorders. High-resolution MRI guidance combined with an accurate method of delivering high doses of transcranial ultrasound energy to a discrete focal point has led to the exploration of noninvasive treatments for diseases traditionally treated by invasive surgical procedures. In this review, the authors examine the current intracranial applications under investigation and explore other potential uses for MRgFUS in the intracranial space based on their initial cadaveric studies. 215Abbreviations used in this paper: ICH = intracerebral hemorrhage; MRgFUS = magnetic resonance-guided focused ultrasound surgery; TCCD = transcranial color-coded duplex; TCD = transcranial Doppler; tPA = tissue plasminogen activator.

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“…Previous reports have shown that US can accelerate fibrinolysis in vivo, but they differ from our findings in several respects. 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.…”

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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Ultrasonic angioplasty in totally occluded peripheral arteries. Initial clinical, histological, and angiographic results.

Abstract: Ultrasonic angioplasty may be a useful clinical method for recanalization of total occlusions in patients with peripheral vascular disease. Ultrasonic energy appears to cause controlled injury to the atherosclerotic intima by selectively disrupting the ultrasound-sensitive occlusion.

Cited by 96 publications

References 19 publications

Enhancement of fibrinolysis in vitro by ultrasound.

Enhancement of fibrinolysis in vitro by ultrasound.

Potential intracranial applications of magnetic resonance–guided focused ultrasound surgery

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

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