Drobinski G, Philippe F, Bucherer C, Ankri A, Lacombe C, Kremer D, Brisset D, Montalescot G, Thomas D, Grosgogeat Y
Service de cardiologie, CHU Pitié-Salpêtrière, Paris.
Arch Mal Coeur Vaiss. 1993 Jun;86(6):915-20.
Ultrasound may be used to dissolve arterial and venous thrombi. Its effects depends on the mode of ultrasonic vibration and on the length of the guide wire. The authors studied the in vitro effects of an ultrasonic angioplasty device coupled with a 130 cm long titanium flexible guide wire. The system comprises an automatic scanning function to determine the optimal frequency of resonance and works in the continuous mode of emission. Sixteen thrombi were studied of which 8 were acellular and 8 whole blood. In each group, 4 were treated in association with streptokinase and 4 by ultrasound alone. The ages of the thrombi in each subgroup were 1, 3, 7 and 15 days. All the thrombi were dissolved in 6 minutes or less (3'15" +/- 1'35") at an average optimal frequency of resonance of 19,444 Hz. Ninety six per cent of the debris had a diameter less than 10 microns. Less than 1% of the debris had a diameter larger than 100 microns. These large particles were observed in cellular thrombi and were almost completely absent in dissolved acellular thrombi. They were very fragile. The dissolution of the thrombi was not accelerated by the association of streptokinase. The ultrasonic energy did not induce D-dimer production and its action was probably due to cavitation. Ultrasonic energy could provide an alternative treatment for thrombotic vascular occlusion provided that more flexible guide wires could be designed.
超声波可用于溶解动脉和静脉血栓。其效果取决于超声振动模式和导丝长度。作者研究了一种超声血管成形术设备与一根130厘米长的钛制柔性导丝相结合的体外效果。该系统具有自动扫描功能以确定最佳共振频率，并以连续发射模式工作。研究了16个血栓，其中8个为无细胞血栓，8个为全血血栓。在每组中，4个与链激酶联合治疗，4个仅用超声治疗。每个亚组中血栓的年龄分别为1天、3天、7天和15天。所有血栓在平均最佳共振频率19444赫兹下6分钟或更短时间内（3分15秒±1分35秒）溶解。96%的碎片直径小于10微米。直径大于100微米的碎片不到1%。这些大颗粒在细胞血栓中观察到，在溶解的无细胞血栓中几乎完全不存在。它们非常脆弱。链激酶联合使用并未加速血栓溶解。超声能量未诱导D-二聚体产生，其作用可能归因于空化作用。只要能设计出更灵活的导丝，超声能量可为血栓性血管闭塞提供一种替代治疗方法。
