Philippe F, Drobinski G, Bucherer C, Ankri A, Lacombe C, Kremer D, Brisset D, Montalescot G
Department of Cardiology, Centre Hospitaller Universitaire Pitié Salpétrière, Paris, France.
Cathet Cardiovasc Diagn. 1993 Feb;28(2):173-8. doi: 10.1002/ccd.1810280217.
Ultrasonic energy may be used for dissolution of venous or arterial thrombi. However, its effects may depend on the mode of ultrasonic vibration and on the length of the probe. We investigated the in vitro effects of an ultrasonic angioplasty device coupled with a 130 cm-long flexible titanium probe, with an incorporated automatic optimal frequency of resonance scanning function and continuous mode of emission. Sixteen clots were treated of which eight were whole blood and eight cell-free. In each of these groups, four were treated in association with streptokinase and four by ultrasound alone. The ages of the clots in these subgroups of four were 1, 3, 7, and 15 days. All thrombi were dissolved in 6 min or less (3'15" +/- 1'35") at a mean optimal frequency of resonance of 19,444 Hz. Ninety-six percent of the debris were less than 10 mu. Fewer than 1% of the particulates were larger than 100 mu. These large particulates were observed in disrupted whole blood clots and were almost non-existent in disrupted cell-free clots. They were very fragile. Clot dissolution was not speeded by adding streptokinase to ultrasound. Ultrasound did not induce D-Dimer production, and its effect was most likely to be due to cavitation. Ultrasound energy could represent an advance for thrombotic vascular occlusion therapy, provided that more flexible probes can be devised.
超声能量可用于溶解静脉或动脉血栓。然而，其效果可能取决于超声振动模式和探头长度。我们研究了一种超声血管成形术设备的体外效果，该设备配有一根130厘米长的柔性钛探头，具有内置的自动最佳频率共振扫描功能和连续发射模式。共处理了16个血栓，其中8个为全血血栓，8个为无细胞血栓。在这些组中，每组4个血栓联合链激酶治疗，4个血栓仅用超声治疗。这4个亚组中的血栓分别为1天、3天、7天和15天龄。所有血栓在平均最佳共振频率为19444赫兹的情况下，在6分钟或更短时间内（3分15秒±1分35秒）溶解。96%的碎片小于10微米。小于1%的颗粒大于100微米。这些大颗粒在破碎的全血血栓中可见，在破碎的无细胞血栓中几乎不存在。它们非常脆弱。向超声中添加链激酶并没有加快血栓溶解速度。超声没有诱导D - 二聚体产生，其作用最可能是由于空化作用。如果能设计出更灵活的探头，超声能量可能代表血栓性血管闭塞治疗的一项进展。
