Coronary and Microvascular Thrombolysis with Guided Diagnostic Ultrasound and Microbubbles in Acute ST Segment Elevation Myocardial Infarction - 24/11/11
Reprint requests: Thomas R. Porter, MD, University of Nebraska Medical Center, Department of Internal Medicine, Division of Cardiology, 982265 Nebraska Medical Center, Omaha, NE 68198-2265.Abstract |
Background |
During a microbubble infusion, guided high–mechanical index impulses from a diagnostic two-dimensional transducer improve microvascular recanalization in acute ST-segment elevation myocardial infarction. The purpose of this study was to further elucidate the mechanism of improved microvascular flow in normal and hyperlipidemic atherosclerotic pigs.
Methods |
In 14 otherwise normal pigs, acute left anterior descending thrombotic coronary occlusions were created. Pigs subsequently received aspirin, heparin, and half-dose fibrinolytic agent (tenecteplase or tissue plasminogen activator), followed by randomization to either no additional treatment (group I) or a continuous infusion of nontargeted microbubbles and guided high–mechanical index impulses from a three-dimensional transducer (group II). Epicardial recanalization rates, ST-segment resolution, microsphere-derived myocardial blood flow, and ultimate infarct size using myocardial contrast echocardiography were compared. The same coronary thrombosis was created in a set of 12 hypercholesterolemic pigs, which were then treated with the same pharmacologic and ultrasound regimen (group III, n = 6) or the pharmacologic regimen alone (group IV, n = 6).
Results |
Epicardial recanalization rates in groups I and II were the same (29%), but peri-infarct myocardial blood flow and ultimate infarct size improved after treatment in group II (P < .01 vs group I). In group III, epicardial recanalization was 100% (vs. 50% in group IV), and there were significant reductions in ultimate infarct size (P = .02 compared with group IV).
Conclusions |
Guided high–mechanical index impulses from a diagnostic transducer and nontargeted microbubbles improve peri-infarct microvascular flow in acute ST-segment elevation myocardial infarction, even when epicardial recanalization does not occur.
Le texte complet de cet article est disponible en PDF.Keywords : Ultrasound, Thrombolysis, Myocardial blood flow, Microbubbles, Therapeutic
Abbreviations : LAD, MBF, MI, 3D, TIMI
Plan
| This work was supported by grant 2R44 HL071433-02 from the National Heart, Lung, and Blood Institute (Bethesda, MD); in part by grant R01 EB009050-03 from the National Institute of Biomedical Imaging and Bioengineering (Bethesda, MD); and by the Theodore Hubbard Foundation (Omaha, NE). Instrumentation support was provided by Philips Medical Systems (Andover, MA). Dr. Porter has received grant support from Lantheus Medical Imaging (North Billerica, MA) and NuvOx Pharma Inc. (Tucson, AZ) and equipment support from Philips Medical Systems and is a consultant for Lantheus Medical Imaging. Dr. Unger is a shareholder in NuvOx Pharma Inc. Dr. Matsunaga is a shareholder in NuvOx Pharma Inc. |
Vol 24 - N° 12
P. 1400-1408 - décembre 2011 Retour au numéro
Article précédent
- Biventricular Performance in Patients with Marfan Syndrome without Significant Valvular Disease: Comparison to Normal Subjects and Longitudinal Follow-Up
- Roderick W.C. Scherptong, Hubert W. Vliegen, Ernst E. van der Wall, Yvonne Hilhorst-Hofstee, Jeroen J. Bax, Arthur J. Scholte, Victoria Delgado
- Giving Thanks
- James Thomas
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