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(Circulation. 1997;95:1360-1362.)
© 1997 American Heart Association, Inc.

Articles

Catheter-Based Ultrasound Thrombolysis

Shake, Rattle, and Reperfuse

Paul G. Yock, MD; Peter J. Fitzgerald, MD, PhD

the Division of Cardiovascular Medicine, Stanford (Calif) University Medical School.

Correspondence to Paul G. Yock, MD, Acting Chief, Division of Cardiovascular Medicine, H3554, Stanford University Medical Center, 300 Pasteur Ave, Stanford, CA 94305.

Key Words: Editorials • thrombolysis • ultrasonics • catheters

	Introduction

 
Therapeutic ultrasound—the use of high-intensity, low- frequency ultrasound to ablate pathological tissues—has found a role in several different specialties during the past 10 years. By far the most common application is the noninvasive disintegration of kidney and gallstones (lithotripsy). An ultrasound scalpel has been developed and is primarily used for extraction of intracranial and hepatic tumors. In cardiology, we have been introduced to therapeutic ultrasound for aortic valve decalcification.

These applications are all based on the fact that ultrasound, at the right combination of frequency and amplitude, will vigorously disrupt abnormal, inelastic tissue while healthy tissue in the same region simply shakes off the injection of energy. This principle of differential destruction is familiar from low-amplitude cutters such as the cast saw or the rotational atherectomy device. These devices work because compliant tissue is able to move out of the way of the short, quick displacements of the cutting element.

The potential for using therapeutic ultrasound to treat atherosclerosis and thrombosis has been appreciated for decades, but actual development efforts were slow to get under way. Catheter-based delivery systems for therapeutic ultrasound were first conceived and patented in the 1960s.^{1 2} Dedicated in vivo experimental work began in the early 1970s with the demonstration by Sobbe and colleagues³ that ultrasound delivered through a wire probe could be used to disrupt blood clots in animals. As with many other technologies in cardiology, however, it was the explosive growth of angioplasty in the 1980s that brought attention, funding, and real momentum to the . . . [Full Text of this Article]

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