诊断性超声联合糖蛋白IIb/IIIa靶向微泡可改善急性冠状动脉血栓闭塞后的微血管恢复。
Diagnostic ultrasound combined with glycoprotein IIb/IIIa-targeted microbubbles improves microvascular recovery after acute coronary thrombotic occlusions.
作者信息
Xie Feng, Lof John, Matsunaga Terry, Zutshi Reena, Porter Thomas R
机构信息
Department of Internal Medicine, Section of Cardiology, University of Nebraska Medical Center, Omaha, NE 68198-2265, USA.
出版信息
Circulation. 2009 Mar 17;119(10):1378-85. doi: 10.1161/CIRCULATIONAHA.108.825067. Epub 2009 Mar 2.
BACKGROUND
The high mechanical index (MI) impulses from a diagnostic ultrasound transducer may be a method of recanalizing acutely thrombosed vessels if the impulses are applied only when microbubbles are channeling through the thrombus.
METHODS AND RESULTS
In 45 pigs with acute left anterior descending thrombotic occlusions, a low-MI pulse sequence scheme (contrast pulse sequencing) was used to image the myocardium and guide the delivery of high-MI (1.9 MI) impulses during infusion of either intravenous platelet-targeted microbubbles or nontargeted microbubbles. A third group received no diagnostic ultrasound and microbubbles. All groups received half-dose recombinant prourokinase, heparin, and aspirin. Contrast pulse sequencing examined replenishment of contrast within the central portion of the risk area and guided the application of high-MI impulses. Angiographic recanalization rates, resolution of ST-segment elevation on ECG, and wall thickening were analyzed. Pigs receiving platelet-targeted microbubbles had more rapid replenishment of the central portion of the risk area (80% versus 40% for nontargeted microbubbles; P=0.03) and higher epicardial recanalization rates (53% versus 7% for prourokinase alone; P=0.01). Replenishment of contrast within the risk area (whether with platelet-targeted microbubbles or nontargeted microbubbles) was associated with both higher recanalization rates and even higher rates of ST-segment resolution (82% versus 21% for prourokinase alone; P=0.006). ST-segment resolution occurred in 6 pigs (40%) treated with microbubbles who did not have epicardial recanalization, of which 5 had recovery of wall thickening.
CONCLUSIONS
Intravenous platelet-targeted microbubbles combined with brief high-MI diagnostic ultrasound impulses guided by contrast pulse sequencing improve both epicardial recanalization rates and microvascular recovery.
背景
如果仅在微泡通过血栓时施加诊断超声换能器发出的高机械指数（MI）脉冲，那么这些脉冲可能是使急性血栓形成的血管再通的一种方法。
方法与结果
在45只患有急性左前降支血栓闭塞的猪中，采用低MI脉冲序列方案（对比脉冲序列）对心肌进行成像，并在静脉注射血小板靶向微泡或非靶向微泡期间指导高MI（1.9 MI）脉冲的递送。第三组未接受诊断超声和微泡。所有组均接受半剂量重组尿激酶原、肝素和阿司匹林。对比脉冲序列检查了危险区域中心部分的造影剂补充情况，并指导高MI脉冲的应用。分析了血管造影再通率、心电图上ST段抬高的消退情况以及室壁增厚情况。接受血小板靶向微泡的猪危险区域中心部分的造影剂补充更快（靶向微泡组为80%，非靶向微泡组为40%；P = 0.03），心外膜再通率更高（仅尿激酶原组为7%，联合血小板靶向微泡组为53%；P = 0.01）。危险区域内造影剂的补充（无论是血小板靶向微泡还是非靶向微泡）与更高的再通率以及更高的ST段消退率相关（仅尿激酶原组为21%，联合微泡组为82%；P = 0.006）。6只接受微泡治疗但无心外膜再通的猪出现了ST段消退，其中5只室壁增厚恢复。
结论
静脉注射血小板靶向微泡并结合由对比脉冲序列引导的短暂高MI诊断超声脉冲可提高心外膜再通率和微血管恢复情况。
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