(Circulation. 2000;101:2026.)
© 2000 American Heart Association, Inc.
Brief Rapid Communications |
Noninvasive, Transthoracic, Low-Frequency Ultrasound Augments Thrombolysis in a Canine Model of Acute Myocardial Infarction
From the Division of Cardiology, Department of Medicine, Cedars-Sinai Medical Center, Los Angeles, Calif.
Correspondence to Robert J. Siegel, MD, Division of Cardiology, Room 5335, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, Los Angeles, CA 90048. E-mail siegel{at}cshs.org
Background—Limitations of coronary thrombolysis include the time to reperfusion, patency rate, and bleeding. We evaluated the use of noninvasive transcutaneous ultrasound to augment coronary thrombolysis.
Methods and Results—In 24 dogs, a thrombotic occlusion of the
left anterior descending coronary artery was induced and
documented by 12-lead ECG and coronary angiography. After 
60
minutes of occlusion, tissue-type plasminogen
activator (t-PA; 1.42 mg/kg) was given
intravenously over 90 minutes. A total of 12 of the 24 dogs
had concomitant transcutaneous application of low-frequency ultrasound
(27 kHz) over the chest. At 90 minutes, the mean TIMI grade flow in the
t-PA alone group was 0.92±1.4 compared with 2.42±1.9 in the t-PA plus
ultrasound group (P=0.006). TIMI 2 to 3 flow was
present in 4 of 12 cases receiving t-PA alone compared with 10 of
12 cases receiving t-PA plus ultrasound (P=0.003). At
180 minutes, mean TIMI grade flow was 0.75±1.4 in the t-PA alone group
versus 2.58±0.9 in the t-PA plus ultrasound group
(P=0.001). Pathological examination confirmed the
angiographic patency rate and did not reveal injury secondary to
ultrasound in the skin, soft tissues, heart, or lungs.
Conclusions—In vivo, the noninvasive transthoracic application of low-frequency ultrasound (1) greatly augments the efficacy of t-PA–mediated thrombolysis, (2) seems safe, and (3) has substantial potential as a noninvasive adjunct to improve coronary patency without increasing the risk of bleeding.
Key Words: thrombolysis • myocardial infarction • ultrasonics • fibrinolysis
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