Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Curr Cardiol Rep. 2021 Aug 19;23(10):133. doi: 10.1007/s11886-021-01563-7.
High mechanical index impulses from a diagnostic transducer are utilized in myocardial perfusion imaging, but can also be utilized therapeutically in three cardiovascular applications: (a) thrombus dissolution (sonothrombolysis), (b) improving microvascular flow in ischemic territories (sonoperfusion), and (c) targeted drug and nucleic acid delivery. The targeted therapeutic effect appears to be based on acoustic cavitation of the intravascular microbubbles which results in endothelial shear and pore formation, as well as mechanical destruction of thrombi.
Within the last 5 years, clinical trials have been performed in acute myocardial infarction demonstrating successful reductions in myocardial infarct size with sonothrombolysis added to current guideline-based treatment. In patients with severe peripheral arterial disease, brief improvements in calf microvascular blood flow have been observed for 1 h after 10 min of sonoperfusion therapy. Targeted ultrasound therapies are developing for prevention of microvascular obstruction in acute coronary syndromes and peripheral vascular disease.
诊断换能器的高机械指数脉冲可用于心肌灌注成像，但也可在三个心血管应用中进行治疗性应用：（a）血栓溶解（声溶栓），（b）改善缺血区域的微血管血流（声灌注），以及（c）靶向药物和核酸递药。靶向治疗效果似乎基于血管内微泡的声空化，导致内皮剪切和孔形成，以及血栓的机械破坏。
在过去的 5 年中，已经在急性心肌梗死中进行了临床试验，结果表明，在基于现有指南的治疗基础上增加声溶栓可成功减少心肌梗死面积。在患有严重外周动脉疾病的患者中，在 10 分钟的声灌注治疗后 1 小时观察到小腿微血管血流短暂改善。正在开发靶向超声疗法以预防急性冠状动脉综合征和外周血管疾病中的微血管阻塞。
