Coronary and microvascular thrombolysis with guided diagnostic ultrasound and microbubbles in acute ST segment elevation myocardial infarction

Feng Xie, Jeroen Slikkerveer, Shunji Gao, John Lof, Otto Kamp, Evan Unger, Stanley J Radio, Terry Matsunaga, Thomas Richard Porter

Research output: Contribution to journalArticle

36 Citations (Scopus)

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.

Original languageEnglish (US)
Pages (from-to)1400-1408
Number of pages9
JournalJournal of the American Society of Echocardiography
Volume24
Issue number12
DOIs
StatePublished - Dec 1 2011

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Microbubbles
Ultrasonography
Swine
Transducers
Coronary Thrombosis
Fibrinolytic Agents
Coronary Occlusion
Tissue Plasminogen Activator
Random Allocation
Microspheres
Aspirin
Echocardiography
Heparin
Myocardial Infarction
ST Elevation Myocardial Infarction

Keywords

  • Microbubbles
  • Myocardial blood flow
  • Therapeutic
  • Thrombolysis
  • Ultrasound

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging
  • Cardiology and Cardiovascular Medicine

Cite this

Coronary and microvascular thrombolysis with guided diagnostic ultrasound and microbubbles in acute ST segment elevation myocardial infarction. / Xie, Feng; Slikkerveer, Jeroen; Gao, Shunji; Lof, John; Kamp, Otto; Unger, Evan; Radio, Stanley J; Matsunaga, Terry; Porter, Thomas Richard.

In: Journal of the American Society of Echocardiography, Vol. 24, No. 12, 01.12.2011, p. 1400-1408.

Research output: Contribution to journalArticle

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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.",
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T1 - Coronary and microvascular thrombolysis with guided diagnostic ultrasound and microbubbles in acute ST segment elevation myocardial infarction

AU - Xie, Feng

AU - Slikkerveer, Jeroen

AU - Gao, Shunji

AU - Lof, John

AU - Kamp, Otto

AU - Unger, Evan

AU - Radio, Stanley J

AU - Matsunaga, Terry

AU - Porter, Thomas Richard

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AB - 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.

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