Joint Division of Pediatric Cardiology, University of Nebraska, Children's Hospital and Medical Center, Omaha, Nebraska 68196, USA.
J Am Soc Echocardiogr. 2010 Sep;23(9):1001-6. doi: 10.1016/j.echo.2010.06.024. Epub 2010 Aug 8.
Central venous and arterial catheters are a major source of thromboembolic disease in children. The investigators hypothesized that guided high-mechanical index (MI) impulses from diagnostic three-dimensional (3D) ultrasound during an intravenous microbubble infusion could dissolve these thrombi.
An in vitro system simulating intracatheter thrombi was created and then treated with guided high-MI impulses from 3D ultrasound, using low-MI microbubble sensitive imaging pulse sequence schemes to detect the microbubbles. Ten aged thrombi >24 hours old were tested using 3D ultrasound coupled with a continuous diluted microbubble infusion (group A) and 10 with 3D ultrasound alone (group B).
The mean thrombus age was 28.6 hours (range, 26.6-30.3 hours). Group A exhibited a 55 +/- 19% reduction in venous thrombus size compared with 31 +/- 10% in group B (P = .008). Feasibility testing was performed in four pigs, establishing an in vivo model to investigate further the efficacy of this approach.
Sonothrombolysis of aged intracatheter venous thrombi can be achieved with commercially available microbubbles and guided high-MI ultrasound from a diagnostic 3D transducer.
中心静脉和动脉导管是儿童血栓栓塞性疾病的主要来源。研究人员假设，在静脉内微泡输注期间，使用诊断性三维（3D）超声引导的高机械指数（MI）脉冲可以溶解这些血栓。
创建了一个模拟导管内血栓的体外系统，然后使用 3D 超声引导的高 MI 脉冲进行处理，使用低 MI 微泡敏感成像脉冲序列方案来检测微泡。使用 3D 超声联合连续稀释微泡输注（A 组）和 10 个单独使用 3D 超声（B 组）测试了 10 个超过 24 小时的陈旧血栓。
平均血栓年龄为 28.6 小时（范围，26.6-30.3 小时）。与 B 组的 31 +/- 10%相比，A 组的静脉血栓大小减少了 55 +/- 19%（P =.008）。在四只猪中进行了可行性测试，建立了一个体内模型，以进一步研究这种方法的疗效。
使用市售微泡和诊断性 3D 换能器的引导高 MI 超声可以实现陈旧的导管内静脉血栓的超声溶栓。
