Luo H, Nishioka T, Fishbein M C, Cercek B, Forrester J S, Kim C J, Berglund H, Siegel R J
Division of Cardiology, Cedars-Sinai Medical Center, Los Angeles, Calif 90048, USA.
Circulation. 1996 Aug 15;94(4):775-8. doi: 10.1161/01.cir.94.4.775.
External ultrasound has a synergistic effect on thrombus disruption with thrombolytic agents in vitro. We hypothesized that transcutaneous ultrasound could augment thrombolysis in vivo.
Thrombus formation was induced electrically in 48 pairs of iliofemoral arteries of 24 rabbits; arterial occlusions were documented angiographically. In 17 of 24 rabbits, 25000 units/kg streptokinase was then administered intravenously. The pairs of iliofemoral arteries were randomized to receive ultrasound treatment or no ultrasound treatment. Low-frequency (26 kHz) ultrasound (continuous wave, 18 W/cm2) was applied transcutaneously over the area of occlusion. In 7 of 24 rabbits, 14 thrombotically occluded iliofemoral arteries were exposed to ultrasound alone without streptokinase. The results were evaluated through the use of angiography (TIMI grade flow) and histopathology. After 30 +/- 10 minutes of activated sonication combined with intravenous streptokinase, 10 of 17 iliofemoral arteries (59%) treated with transcutaneous ultrasound were widely patent angiographically, with TIMI grade 3 flow. Histologically, the patent arteries had only minimal focal moral thrombus. The angiographic patency rate was significantly lower in the control groups: 1 of 17 arteries (6%) treated with streptokinase alone (P = .0012) and 1 of 14 arteries (7%) treated with ultrasound alone (P = .0036).
In vivo transcutaneous ultrasound significantly augments lysis of thrombi with streptokinase in rabbit iliofemoral arteries.
体外实验中，体外超声与溶栓剂对血栓溶解具有协同作用。我们推测经皮超声可增强体内溶栓效果。
对24只家兔的48对髂股动脉进行电刺激诱导血栓形成；通过血管造影记录动脉闭塞情况。24只家兔中的17只随后静脉注射25000单位/千克链激酶。将成对的髂股动脉随机分为接受超声治疗组或不接受超声治疗组。在闭塞区域经皮施加低频（26千赫）超声（连续波，18瓦/平方厘米）。24只家兔中的7只，14条血栓闭塞的髂股动脉仅接受超声治疗，未使用链激酶。通过血管造影（TIMI血流分级）和组织病理学评估结果。在激活超声与静脉注射链激酶联合作用30±10分钟后，17条接受经皮超声治疗的髂股动脉中有10条（59%）血管造影显示广泛通畅，TIMI血流分级为3级。组织学检查显示，通畅的动脉仅有极少的局灶性附壁血栓。对照组的血管造影通畅率显著较低：仅接受链激酶治疗的17条动脉中有1条（6%）（P = .0012），仅接受超声治疗的14条动脉中有1条（7%）（P = .0036）。
在兔髂股动脉中，经皮超声可显著增强链激酶对血栓的溶解作用。
