心血管声溶栓。
Cardiovascular Sonothrombolysis.
机构信息
Department of Internal Medicine, Division of Cardiovascular Medicine, University of Nebraska Medical Center, 982265 Nebraska Medical Center, Omaha, NE, 68198, USA.
Departamento de Cardiopneumologia da Faculdade de Medicina, University of Sao Paulo School of Medicine, Sao Paulo, State of Sao Paulo, 03178-200, Brazil.
出版信息
Curr Cardiol Rep. 2019 Jul 25;21(8):86. doi: 10.1007/s11886-019-1167-z.
PURPOSE OF REVIEW
This review will provide recent pre-clinical and initial clinical trials exploring the efficacy of sonothrombolysis as an adjunct to current emergent therapies in acute coronary syndromes.
RECENT FINDINGS
The initial clinical trials examining the efficacy of short pulse duration diagnostic ultrasound (DUS) high mechanical index impulses in patients with ST segment elevation myocardial infarction (STEMI) have demonstrated that there is improved patency of the infarct vessel, and improved microvascular flow following percutaneous coronary intervention. Subsequent randomized prospective trials have confirmed that in patients with acute STEMI receiving an intravenous microbubble infusion, diagnostic high mechanical index impulses applied in the apical windows pre- and post-percutaneous coronary intervention have reduced myocardial infarction size, as assessed by magnetic resonance imaging at 72 h following presentation, and have been associated with better left ventricular systolic function at 6 month follow-up. Sonothrombolysis has potential for improving early epicardial coronary artery patency and reduce left ventricular remodeling when added to current interventional strategies in STEMI.
目的综述
本文综述了近期的临床前和初步临床试验，探索了超声溶栓作为急性冠状动脉综合征中现有紧急治疗方法的辅助手段的疗效。
研究发现
初步临床试验研究了短脉冲持续时间诊断超声（DUS）高机械指数脉冲在 ST 段抬高型心肌梗死（STEMI）患者中的疗效，结果表明梗死血管的通畅性得到改善，经皮冠状动脉介入治疗后微血管血流得到改善。随后的随机前瞻性试验证实，在接受静脉内微泡输注的急性 STEMI 患者中，经皮冠状动脉介入治疗前和后在心尖窗应用诊断性高机械指数脉冲可减少磁共振成像评估的心肌梗死面积72 h 后就诊，与 6 个月随访时更好的左心室收缩功能相关。超声溶栓在 STEMI 中与现有介入策略联合应用，有可能改善早期心外膜冠状动脉通畅性，减少左心室重构。
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