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(Circulation. 1998;97:130-134.)
© 1998 American Heart Association, Inc.

Brief Rapid Communications

Noninvasive In Vivo Clot Dissolution Without a Thrombolytic Drug

Recanalization of Thrombosed Iliofemoral Arteries by Transcutaneous Ultrasound Combined With Intravenous Infusion of Microbubbles

Yochai Birnbaum, MD; Huai Luo, MD; Tomoo Nagai, MD; Michael C. Fishbein, MD; Thomas M. Peterson, MBA; Shouping Li, MD; David Kricsfeld; Thomas R. Porter, MD; ; Robert J. Siegel, MD

From the Divisions of Cardiology (Y.B., H.L., T.N., R.J.S.) and Anatomic Pathology (M.C.F.), Cedars-Sinai Medical Center, Los Angeles, Calif, and the Section of Cardiology (S.L., D.K., T.R.P.), University of Nebraska Medical Center, Omaha, Neb.

Correspondence to Robert J. Siegel, MD, Division of Cardiology, Room 5335, 8700 Beverly Blvd, Los Angeles, CA 90048. E-mail siegel{at}csmc.edu

Background—Previous in vivo studies have shown that microbubbles not only enhance the effectiveness of thrombolytic agents in the presence of ultrasound but may also augment clot dissolution without thrombolytic drugs.

Methods and Results—The objective of this study was to examine the efficacy of arterial clot disruption by a noninvasive, nonlytic approach with intravenous administration of perfluorocarbon-exposed sonicated dextrose albumin (PESDA) and transcutaneous delivery of ultrasound alone. Pairs of iliofemoral arteries in 10 rabbits were randomized to receive transcutaneous ultrasound treatment or no ultrasound treatment after an acute artery thrombotic occlusion and intravenous PESDA infusion. Five arteries from 3 additional rabbits served as controls (ultrasound alone). All 10 iliofemoral arteries treated with PESDA+ultrasound were recanalized by angiography after ultrasound treatment. None of the 10 contralateral arteries treated with PESDA alone and none of the 5 arteries treated with ultrasound alone were patent after 1 hour. D-Dimer levels did not change after intravenous PESDA+ultrasound–mediated reperfusion.

Conclusions—In vivo arterial clot dissolution can be achieved with intravenous microbubbles and transcutaneous ultrasound delivery alone. This technique has potential for clinical application in patients with acute arterial and venous thrombotic occlusions.

Key Words: thrombosis • ultrasonics • occlusion

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