Ultrasound Enhanced Prehospital Thrombolysis Using Microbubbles Infusion in Patients with Acute ST Elevation Myocardial Infarction: Pilot of the Sonolysis Study

Slikkerveer, Jeroen; Kleijn, Sebastiaan A.; Appelman, Yolande; Porter, Thomas R.; Veen, Gerrit; Rossum, Albert C. van; Kamp, Otto

doi:10.1016/j.ultrasmedbio.2011.11.001

Cited by 39 publications

(24 citation statements)

References 30 publications

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“…Because of the low number of patients included thus far, no statistical difference in epicardial coronary recanalization rate was observed and no difference in cardiac function was observed during follow-up. No serious adverse events occurred and the study design was deemed feasible and safe [11].…”

Section: Sonothrombolysis In Acute Coronary Syndromesmentioning

confidence: 96%

“…An example of an area in which microbubbles and sonothrombolysis are being investigated clinically is in ischemic stroke patients [9,11]. After the discovery of a potential beneficial effect of pulsed wave Doppler ultrasound combined with recombinant tissue plasminogen activator (rTPA) in patients with acute ischemic stroke [12], several studies have now been performed investigating the effect of ultrasound and rTPA in patients with ischemic stroke.…”

Section: Introductionmentioning

confidence: 99%

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Sonothrombolysis in acute stroke and myocardial infarction: A systematic review

Roos

Juffermans

Slikkerveer

et al. 2014

IJC Heart & Vessels

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a b s t r a c tIntroduction: Current treatment of patients with an acute occlusion of a cranial or a coronary artery, in for example ST segment elevation myocardial infarction (STEMI), consists of either thrombolysis or percutaneous intervention. Various thrombolytic agents (tissue plasminogen activators) are used for reperfusion therapy in patients with STEMI. However, their use may be associated with an increased risk of bleeding which is inherent to their action mechanism. Therefore, new methods of coronary clot resolution are being studied in an attempt to potentiate the efficacy and reduce the side effects of thrombolytics. A new method is ultrasound mediated thrombus dissolution, or sonothrombolysis. The current literature exploring sonothrombolysis is diverse in size and quality. In this systematic review of the current literature, we describe cardiovascular applications of sonothrombolysis in patients. A comparison to the neurovascular application in ischemic stroke is made, as more research has been performed on patients suffering from stroke. Methods: A systematic search was performed following the PRISMA guidelines using EMBASE and MEDLINE databases regarding sonothrombolysis in human ischemic stroke and acute myocardial infarction patients. Results: 12 original case-control or randomized controlled trials using a combination of ultrasound and microbubbles were found. 6 trials studied ischemic stroke, and 6 trials studied acute myocardial infarction. Conclusion: This systematic review provides up to date information on the subject of sonothrombolysis.

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Section: Sonothrombolysis In Acute Coronary Syndromesmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Sonothrombolysis in acute stroke and myocardial infarction: A systematic review

Roos

Juffermans

Slikkerveer

et al. 2014

IJC Heart & Vessels

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“…Sonothrombolysis 2,4 is a noninvasive procedure to break down blood clots using focused ultrasound (US) waves. Sonothrombolysis is shown to have higher efficiency in the presence of microbubbles [5][6][7] and thrombolytic agents, such as tissue plasminogen activator. 8,9 During clinical trials of sonothrombolysis 10,11 for the noninvasive treatment of acute ischemic stroke, magnetic resonance imaging (MRI) and computed tomography (CT) angiography were performed to assess recanalization of the occluded blood vessels.…”

Section: Introductionmentioning

confidence: 99%

“…In this work, a combined US and PA imaging system is used to image a blood clot during microbubble-assisted sonothrombolysis. Microbubbles were used because they enhance the sonothrombolysis efficiency [5][6][7] and are currently undergoing clinical trials. 10,11 Moreover, microbubbles are already used as US contrast agents.…”

Section: Introductionmentioning

confidence: 99%

Combined ultrasound and photoacoustic imaging of blood clot during microbubble-assisted sonothrombolysis

Das

Pramanik

2019

J. Biomed. Opt.

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Blockage of healthy blood vessels by blood clots can lead to serious or even life-threatening complications. The use of a combined ultrasound (US) and photoacoustic (PA) imaging was explored for blood clot monitoring during microbubble-assisted sonothrombolysis. PA imaging is an emerging hybrid imaging modality that has garnered the attention of the biomedical imaging community in recent years. It enables the study of the composition of a blood clot due to its sensitivity toward optical absorption. Here, in vitro imaging of the side of a blood clot facing the microbubbles was done over time. The US and PA signal-to-noise (SNR) ratio value changes during microbubble-assisted sonothrombolysis were studied for two different local environments: blood clot in deionized water and blood clot in blood. In the first case, US and PA SNR values increased by 4.6% and reduced by 20.8%, respectively after 30 min of sonothrombolysis treatment. After 10 min of sonothrombolysis treatment of the blood clot in blood, the US and PA SNR values increased by 7.7% and 38.3%, respectively. The US and PA SNR value changes were recorded in response to its local environment. This technique can be used to determine the final composition of the blood clot which may, in turn, help in the administration of clot-dissolving drugs.

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“…Most recently, researchers at VU University, The Netherlands, have reported promising results from a pilot study of the Sonolysis trial. Here thrombolysis was achieved in patients with first acute ST elevation myocardial infarction by administration of low-dose tPA along microbubbles with three dimensional-guided high myocardial infarction therapeutic ultrasound (52). In achieving coronary reperfusion with limited negative impact, both safety and efficacy were demonstrated.…”

mentioning

confidence: 99%

Ultrasound-mediated targeted drug delivery: recent success and remaining challenges

Castle

Butts

Healey

et al. 2013

American Journal of Physiology-Heart and Circulatory Physiology

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contrast-enhanced ultrasound; gene therapy; microbubble drug delivery PRESENTLY, CONTRAST-ENHANCED ultrasound (CEUS) imaging focuses on diagnostic clinical applications. In the future, however, therapeutic uses of CEUS will create a paradigm shift for patient care and the pharmaceutical industry. Ultrasound contrast agents (UCAs) are composed of shelled microbubbles that serve as superior diagnostic agents while traversing the smallest of blood vessels resulting in unparalleled, real-time spatial and temporal imaging of intact tissues and organs. These microscopic, gas-filled microspheres acting as intravascular indicators represent ideal carrier vehicles for local delivery of ultrasound-directed drug and gene therapies. The conceptually simple application of external acoustic energy in the transformation of these inert, microspheres into powerful therapeutic systems has seemingly unlimited potential.Brief history of CEUS. All diagnostic imaging modalities use and require contrast effects to increase signal-to-noise ratios, permitting enhanced discrimination of the targets. Examples include the use of radiopaque contrast agents to create discrete image patterns using X-ray methods (ionizing radiation), thus creating enhanced detection of objects within the image plane. Similar to X-ray, positron emission tomography and radionuclide imaging procedures rely on radioactive emitters to highlight anatomy and provide information on cellular metabolism and physiology.

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Ultrasound Enhanced Prehospital Thrombolysis Using Microbubbles Infusion in Patients with Acute ST Elevation Myocardial Infarction: Pilot of the Sonolysis Study

Cited by 39 publications

References 30 publications

Sonothrombolysis in acute stroke and myocardial infarction: A systematic review

Sonothrombolysis in acute stroke and myocardial infarction: A systematic review

Combined ultrasound and photoacoustic imaging of blood clot during microbubble-assisted sonothrombolysis

Ultrasound-mediated targeted drug delivery: recent success and remaining challenges

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