Tsutsui Jeane M, Xie Feng, Johanning Jason, Lof John, Cory Brian, He Amming, Thomas Lewis, Matsunaga Terry, Unger Evan, Porter Thomas R
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, 981165 Nebraska Medical Center, Omaha, 68198-1165 USA.
J Ultrasound Med. 2006 Sep;25(9):1161-8. doi: 10.7863/jum.2006.25.9.1161.
We sought to determine the added value of simultaneous imaging of intravenously infused microbubbles that are being used to dissolve an intravascular thrombus with therapeutic ultrasound (TUS).
In a chronic canine arteriovenous graft occluded by a thrombus, TUS (1 MHz) was applied through a 6-cm-thick tissue-mimicking phantom (measured mean +/- SD peak negative pressure through the phantom, 958 +/- 104 kPa) during an intravenous infusion of either saline (n = 6 occlusions) or lipid-encapsulated microbubbles (ImaRx Therapeutics, Inc, Tucson, AZ). Therapeutic ultrasound was intermittently applied during the microbubble infusion either at set time intervals (n = 6 occlusions) or when simultaneous diagnostic ultrasound (DUS) indicated a sustained presence of microbubbles (n = 12 occlusions). Success was defined as return of rapid flow within the graft (grade 3 flow).
Diagnostic ultrasound showed microbubbles moving through small channels within the thrombus before angiographic evidence of flow in the graft. This guided the timing of TUS application better than using set time intervals. Angiographic clearance of the thrombus and restoration of grade 3 flow at 45 minutes of treatment were seen in 33% of deeply located thrombosed grafts treated with TUS at set time intervals and 92% of grafts treated with TUS guided by DUS (P < .001 compared with set time intervals).
The use of TUS with intravenous microbubbles has a high success rate in recanalizing deeply located thrombosed arteriovenous grafts when performed with DUS guidance.
我们试图确定在使用治疗性超声（TUS）溶解血管内血栓时，对静脉注射微泡进行同步成像的附加价值。
在一只因血栓闭塞的慢性犬动静脉移植物中，在静脉输注生理盐水（n = 6处闭塞）或脂质包裹的微泡（ImaRx Therapeutics公司，图森，亚利桑那州）期间，通过一个6厘米厚的组织模拟体模（经体模测量的平均±标准差峰值负压为958±104千帕）施加TUS（1兆赫）。在微泡输注期间，以设定的时间间隔（n = 6处闭塞）或当同步诊断超声（DUS）显示微泡持续存在时（n = 12处闭塞）间歇性地施加治疗性超声。成功定义为移植物内快速血流恢复（3级血流）。
在移植物出现血管造影血流证据之前，诊断超声显示微泡在血栓内的小通道中移动。这比使用设定的时间间隔能更好地指导TUS应用的时机。在以设定时间间隔进行TUS治疗的深部血栓形成移植物中，33%在治疗45分钟时血栓的血管造影清除及3级血流恢复，而在DUS引导下进行TUS治疗的移植物中，这一比例为92%（与设定时间间隔相比，P < .001）。
在DUS引导下，将TUS与静脉微泡联合使用，在使深部血栓形成的动静脉移植物再通方面成功率很高。
