This Article Full Text (PDF) Alert me when this article is cited Alert me if a correction is posted Citation Map Services Email this article to a friend Similar articles in this journal Similar articles in PubMed Alert me to new issues of the journal Download to citation manager Request Permissions Citing Articles Citing Articles via HighWire Citing Articles via Google Scholar Google Scholar Articles by Ariani, M. Articles by Siegel, R. J. Search for Related Content PubMed PubMed Citation Articles by Ariani, M. Articles by Siegel, R. J.

Circulation, Vol 84, 1680-1688, Copyright © 1991 by American Heart Association

ARTICLES

Dissolution of peripheral arterial thrombi by ultrasound

M Ariani, MC Fishbein, JS Chae, H Sadeghi, AD Michael, SB Dubin and RJ Siegel
Department of Medicine, Cedars Sinai Medical Center, Los Angeles, CA 90048.

BACKGROUND. We have previously shown that continuous-wave ultrasound can rapidly dissolve human thrombi in vitro, with 99% of all residual particles measuring less than 10 microns in diameter. To assess the effects of pulsed-wave ultrasound energy on whole blood clots, 1) in vitro studies were preformed to assess precisely the rates of clot disruption and to quantify particulate size, and 2) in vivo studies were performed to assess the efficacy and safety of catheter-delivered ultrasound for intra-arterial thrombus dissolution. METHODS AND RESULTS. In vitro, we studied 50 samples of human whole blood clots and using an 89-cm-long wire probe, applied pulse-wave energies from 8 to 23 W. The corresponding peak-to-peak tip displacement range was 63.5 - 102 microns. We studied arterial thrombosis in vivo in 21 canine superficial femoral arteries. To produce an acute thrombosis, 200 units of thrombin followed by 2 ml of 72-hour-old autologous clot were injected into a 5-7-cm segment of femoral artery and left to coagulate for 2 hours. Ultrasound energy was intermittently applied at a frequency of 20 kHz with a prototype ultrasound wire ensheathed in a catheter and directed to clots by fluoroscopy. In nine cases, angioscopic guidance was used to put the probe into direct contact with the intra-arterial thromboses. In vitro clot dissolution times were inversely related to the ultrasound power output (r = 0.95). All in vivo canine thromboses were disrupted in 4 minutes or less. All successful recanalizations were confirmed by angiography and in nine cases by angioscopy as well. Angioscopy demonstrated that probe activation caused rapid clot disruption. Histological studies of the vessels showed no evidence of thermal or cavitation injury, occlusive distal embolization, or perforation. CONCLUSIONS. Our findings in this experimental canine model suggest that ultrasound clot dissolution has the potential to be an effective and safe alternative to current treatment modalities for peripheral arterial thrombosis.

This article has been cited by other articles:

				R. J. Siegel, V. N. Suchkova, T. Miyamoto, H. Luo, R. B. Baggs, Y. Neuman, M. Horzewski, V. Suorsa, S. Kobal, T. Thompson, et al. Ultrasound energy improves myocardial perfusion in the presence of coronary occlusion J. Am. Coll. Cardiol., October 6, 2004; 44(7): 1454 - 1458. [Abstract] [Full Text] [PDF]

				D. D. McPherson and C. K. Holland Seizing the science of ultrasound: Beyond imaging and into physiology and therapeutics J. Am. Coll. Cardiol., May 7, 2003; 41(9): 1628 - 1630. [Full Text] [PDF]

				M. Nedelmann, B. M. Eicke, E. G. Lierke, A. Heimann, O. Kempski, and H. C. Hopf Low-Frequency Ultrasound Induces Nonenzymatic Thrombolysis In Vitro J. Ultrasound Med., June 1, 2002; 21(6): 649 - 656. [Abstract] [Full Text] [PDF]

				C. W Francis and V. N Suchkova Ultrasound and thrombolysis Vascular Medicine, August 1, 2001; 6(3): 181 - 187. [Abstract] [PDF]

				P. J. Fitzgerald, A. Takagi, M. P. Moore, M. Hayase, F. D. Kolodgie, D. Corl, M. Nassi, R. Virmani, and P. G. Yock Intravascular Sonotherapy Decreases Neointimal Hyperplasia After Stent Implantation in Swine Circulation, April 10, 2001; 103(14): 1828 - 1831. [Abstract] [Full Text] [PDF]

				V. N. Suchkova, R. B. Baggs, and C. W. Francis Effect of 40-kHz Ultrasound on Acute Thrombotic Ischemia in a Rabbit Femoral Artery Thrombosis Model : Enhancement of Thrombolysis and Improvement in Capillary Muscle Perfusion Circulation, May 16, 2000; 101(19): 2296 - 2301. [Abstract] [Full Text] [PDF]

				V. Suchkova, F. N. Siddiqi, E. L. Carstensen, D. Dalecki, S. Child, and C. W. Francis Enhancement of Fibrinolysis With 40-kHz Ultrasound Circulation, September 8, 1998; 98(10): 1030 - 1035. [Abstract] [Full Text] [PDF]