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

Quantitative Imaging in Medicine and Surgery

article

Shifeng Qiu¹  Shenrong Zhong¹  Qian Feng¹  Yuegang Wang¹  Danxia Li¹  Junzhen Zhan¹  Chuangye Lyu¹  Zhe Deng¹  Daogang Zha¹  Juefei Wu¹ 

[1] Department of Cardiology, Nanfang Hospital , Southern Medical University;Guangdong Provincial Key Laboratory of Shock and Microcirculation , Southern Medical University;Department of Geriatrics, Pingxiang People’s Hospital of Southern Medical University;Department of Cardiology, The People’s Hospital of Wuzhou;Department of Cardiology, Shenzhen People’s Hospital , The Second Affiliated Hospital of Jinan Medical College;Department of Cardiology , The First Affiliated Hospital of Jinan University;Department of General Practice, Nanfang Hospital , Southern Medical University

关键词: Sono-assisted-thrombolysis;    three-dimensional ultrasound (3D US);    acute myocardial infarction;    microcirculation;    recanalization;   

DOI  :  10.21037/qims-21-1247

学科分类：外科医学

来源: AME Publications

【 摘 要 】

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, ST-segment 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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