Zhao Kevin, Saucedo Erik, Basterrechea Katia Flores, Yang Shumeng, Haworth Kevin J, Holland Christy K, Racadio John M, Maxwell Adam D, Cursio John F, Wool Geoffrey D, Ostdiek Allison M, Ahmed Osman S, Paul Jonathan D, Patel Mikin V, Bader Kenneth B
Department of Radiology, University of Chicago, Chicago, Illinois.
Division of Cardiovascular Health and Disease, Department of Internal Medicine, University of Cincinnati, Cincinnati, Ohio.
J Vasc Interv Radiol. 2025 Jun;36(6):1051-1061.e5. doi: 10.1016/j.jvir.2025.01.044. Epub 2025 Jan 29.
The hypothesis of this study was that histotripsy, an ultrasound therapy that disrupts tissue mechanically through the action of bubble clouds, increases the short-term rate of acute thrombus clearance for catheter-directed thrombolysis (CDT) in an animal model.
Thrombi formed in the femoral vein of pigs were treated with CDT, histotripsy, or CDT and histotripsy (histotripsy+). Ultrasound (B-mode and color Doppler) and contrast fluoroscopy imaging data were scored by 4 observers for semiquantitative evaluation of each arm with ordinal regression models. Further, B-mode images were manually annotated by 3 observers to quantify the thrombus clearance rate.
A total of 27 thrombi (2.0 cm [SD ± 0.4] in length) in 27 animals were considered in this study (N = 8 for CDT, N = 9 for histotripsy, and N = 10 for histotripsy+). The mean treatment duration was 20.2 minutes (SD ± 1.3). The ordinal regression models indicated that the thrombus clearance rate increased for histotripsy+ relative to CDT based on B-mode and color Doppler but not fluoroscopy (P = .015, P = .001, and P = .900, respectively). Manual annotation of B-mode images denoted that histotripsy+ had an increased thrombus clearance rate relative to CDT and histotripsy (P = .001 and P = .022, respectively). Petechial hemorrhage was present in the perivascular soft tissue for 2 cases with histotripsy and 1 case with histotripsy+.
The clearance of acute thrombus was similar for treatment with CDT or histotripsy. Combining these individual approaches further increased the rate of thrombus clearance based on multiple imaging metrics.
本研究的假设是，组织超声破碎术（一种通过气泡云的作用机械性破坏组织的超声治疗方法）可提高动物模型中导管定向溶栓（CDT）的急性血栓短期清除率。
对猪股静脉中形成的血栓进行CDT、组织超声破碎术或CDT联合组织超声破碎术（组织超声破碎术+）治疗。4名观察者对超声（B模式和彩色多普勒）及造影荧光透视成像数据进行评分，采用有序回归模型对每组进行半定量评估。此外，3名观察者对B模式图像进行手动标注，以量化血栓清除率。
本研究共纳入27只动物的27个血栓（长度为2.0 cm[标准差±0.4]）（CDT组8个，组织超声破碎术组9个，组织超声破碎术+组10个）。平均治疗时长为20.2分钟（标准差±1.3）。有序回归模型表明，基于B模式和彩色多普勒，组织超声破碎术+组相对于CDT组的血栓清除率有所提高，但荧光透视检查结果并非如此（P值分别为0.015、0.001和0.900）。B模式图像的手动标注显示，组织超声破碎术+组相对于CDT组和组织超声破碎术组的血栓清除率有所提高（P值分别为0.001和0.022）。组织超声破碎术组有2例、组织超声破碎术+组有1例在血管周围软组织出现瘀点性出血。
CDT或组织超声破碎术治疗急性血栓的清除效果相似。基于多种成像指标，联合这两种方法可进一步提高血栓清除率。
