El Kadi Soufiane, Porter Thomas R, Zanstra Mark, Siegers Arjen, van Loon Ramon B, Hopman Luuk H G A, van Rossum Albert C, Kamp Otto
Department of Cardiology, Amsterdam Cardiovascular Sciences, Amsterdam UMC, Location VUmc, De Boelelaan 1117, 1081 HV, Amsterdam, The Netherlands.
Division of Cardiovascular Medicine, University of Nebraska Medical Center, Omaha, NE, USA.
Int J Cardiovasc Imaging. 2022 May;38(5):1089-1098. doi: 10.1007/s10554-021-02487-7. Epub 2021 Dec 7.
Patients with ST-elevation myocardial infarction (STEMI) due to coronary occlusion require immediate restoration of epicardial and microvascular blood flow. A potentially new reperfusion method is the use of ultrasound and microbubbles, also called sonothrombolysis. The oscillation and collapse of intravenously administered microbubbles upon exposure to high mechanical index (MI) ultrasound pulses results in thrombus dissolution and stimulates nitric oxide-mediated increases in tissue perfusion. The aim of this study was to assess feasibility of sonothrombolysis in the ambulance for STEMI patients. Patients presenting with chest pain and ST-elevations on initial electrocardiogram were included. Sonothrombolysis was applied in the ambulance during patient transfer to the percutaneous coronary intervention (PCI) center. Feasibility was assessed based on duration of sonothrombolysis treatment and number of high MI pulses applied. Vital parameters, ST-resolution, pre- and post-PCI coronary flow and cardiovascular magnetic resonance images were analyzed. Follow up was performed at six months after STEMI. Twelve patients were screened, of which three patients were included in the study. Sonothrombolysis duration and number of high MI pulses ranged between 12 and 17 min and 32-60 flashes respectively. No arrhythmias or changes in vital parameters were observed during and directly after sonothrombolysis, although one patient developed in-hospital ventricular fibrillation 20 min after sonothrombolysis completion but before PCI. In one case, sonothrombolysis on top of regular pre-hospital care resulted in reperfusion before PCI. This is the first report on the feasibility of performing sonothrombolysis to treat myocardial infarction in an ambulance. To assess efficacy and safety of pre-hospital sonothrombolysis, clinical trials with greater patient numbers should be performed. EU Clinical Trials Register (identifier: 2019-001883-31), registered 2020-02-25.
因冠状动脉闭塞导致的ST段抬高型心肌梗死（STEMI）患者需要立即恢复心外膜和微血管血流。一种潜在的新的再灌注方法是使用超声和微泡，也称为超声溶栓。静脉注射的微泡在暴露于高机械指数（MI）超声脉冲时发生振荡和塌陷，从而导致血栓溶解，并刺激一氧化氮介导的组织灌注增加。本研究的目的是评估在救护车上对STEMI患者进行超声溶栓的可行性。纳入初始心电图显示胸痛和ST段抬高的患者。在将患者转运至经皮冠状动脉介入治疗（PCI）中心的过程中，在救护车上进行超声溶栓。根据超声溶栓治疗的持续时间和施加的高MI脉冲数量评估可行性。分析生命体征参数、ST段分辨率、PCI术前和术后冠状动脉血流以及心血管磁共振图像。在STEMI发生六个月后进行随访。筛查了12名患者，其中3名患者纳入研究。超声溶栓持续时间和高MI脉冲数量分别在12至17分钟和32 - 60次闪光之间。在超声溶栓期间及之后立即未观察到心律失常或生命体征参数变化，尽管有一名患者在超声溶栓完成后20分钟但在PCI术前发生了院内室颤。在一个病例中，常规院前护理基础上加用超声溶栓导致在PCI术前实现了再灌注。这是关于在救护车上进行超声溶栓治疗心肌梗死可行性的首份报告。为评估院前超声溶栓的疗效和安全性，应开展更大样本量的临床试验。欧盟临床试验注册库（标识符：2019 - 001883 - 31），于2020年2月25日注册。
