TY - JOUR
T1 - Advancements in catheter-directed ultrasound-accelerated thrombolysis
AU - Doomernik, Denise E.
AU - Schrijver, A. Marjolein
AU - Zeebregts, Clark J.
AU - De Vries, Jean Paul P.M.
AU - Reijnen, Michel M.P.J.
PY - 2011/6/1
Y1 - 2011/6/1
N2 - Purpose: To review all available literature on catheter-directed ultrasound-accelerated thrombolysis for peripheral artery occlusions, stroke, deep venous thrombosis, and pulmonary embolism. Methods: A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. A total of 77 reports focusing on catheter-delivered ultrasound-accelerated thrombolysis were identified. Results: Experimental studies show that high intensity ultrasound may induce thrombolysis, with and without the addition of plasminogen activators, mainly by acoustic cavitation and mechanical disruption, while low intensity, high frequency ultrasound waves may actually enhance plasmin-mediated thrombolysis. In a total of 340 clinical cases of various thromboembolic conditions, catheter-directed ultrasound-accelerated thrombolysis was related to rapid revascularization and a reduction in treatment time, drug dosage, hospitalization time, and possibly major bleeding complications compared to standard thrombolysis. Reported complication rates, including bleeding and embolization, were low. Conclusion: Ultrasound enhanced thrombolysis seems to be a promising concept in the treatment of various thromboembolic conditions. The technique has shown to be safe and efficacious in vitro, in vivo, and in clinical studies. Randomized controlled trials are warranted and should be awaited before considering catheter-directed ultrasoundaccelerated thrombolysis as a new standard treatment.
AB - Purpose: To review all available literature on catheter-directed ultrasound-accelerated thrombolysis for peripheral artery occlusions, stroke, deep venous thrombosis, and pulmonary embolism. Methods: A systematic literature search was performed, using MEDLINE, EMBASE and Cochrane databases. A total of 77 reports focusing on catheter-delivered ultrasound-accelerated thrombolysis were identified. Results: Experimental studies show that high intensity ultrasound may induce thrombolysis, with and without the addition of plasminogen activators, mainly by acoustic cavitation and mechanical disruption, while low intensity, high frequency ultrasound waves may actually enhance plasmin-mediated thrombolysis. In a total of 340 clinical cases of various thromboembolic conditions, catheter-directed ultrasound-accelerated thrombolysis was related to rapid revascularization and a reduction in treatment time, drug dosage, hospitalization time, and possibly major bleeding complications compared to standard thrombolysis. Reported complication rates, including bleeding and embolization, were low. Conclusion: Ultrasound enhanced thrombolysis seems to be a promising concept in the treatment of various thromboembolic conditions. The technique has shown to be safe and efficacious in vitro, in vivo, and in clinical studies. Randomized controlled trials are warranted and should be awaited before considering catheter-directed ultrasoundaccelerated thrombolysis as a new standard treatment.
KW - Arterial occlusion
KW - Catheter-directed thrombolysis
KW - Deep venous thrombosis
KW - Pulmonary embolism
KW - Stroke
KW - Ultrasound
UR - http://www.scopus.com/inward/record.url?scp=79959289306&partnerID=8YFLogxK
U2 - 10.1583/10-3362.1
DO - 10.1583/10-3362.1
M3 - Review article
C2 - 21679085
AN - SCOPUS:79959289306
VL - 18
SP - 418
EP - 434
JO - Journal of Endovascular Therapy
JF - Journal of Endovascular Therapy
SN - 1526-6028
IS - 3
ER -