Purpose of Review

High mechanical index impulses from a diagnostic transducer are utilized in myocardial perfusion imaging, but can also be utilized therapeutically in three cardiovascular applications: (a) thrombus dissolution (sonothrombolysis), (b) improving microvascular flow in ischemic territories (sonoperfusion), and (c) targeted drug and nucleic acid delivery. The targeted therapeutic effect appears to be based on acoustic cavitation of the intravascular microbubbles which results in endothelial shear and pore formation, as well as mechanical destruction of thrombi.

Recent Findings

Within the last 5 years, clinical trials have been performed in acute myocardial infarction demonstrating successful reductions in myocardial infarct size with sonothrombolysis added to current guideline-based treatment. In patients with severe peripheral arterial disease, brief improvements in calf microvascular blood flow have been observed for 1 h after 10 min of sonoperfusion therapy.

Summary

Targeted ultrasound therapies are developing for prevention of microvascular obstruction in acute coronary syndromes and peripheral vascular disease.

中文翻译：

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超声治疗的进展

审查目的

来自诊断换能器的高机械指数脉冲可用于心肌灌注成像，但也可用于三种心血管应用的治疗：(a) 血栓溶解（超声溶栓），(b) 改善缺血区域的微血管流动（超声灌注），以及（ c) 靶向药物和核酸递送。靶向治疗效果似乎基于血管内微泡的声空化，这导致内皮剪切和孔隙形成，以及血栓的机械破坏。

最近的发现

在过去的 5 年中，已在急性心肌梗塞中进行了临床试验，证明在当前基于指南的治疗中加入超声溶栓治疗成功地减少了心肌梗塞的面积。在患有严重外周动脉疾病的患者中，在超声灌注治疗 10 分钟后观察到小腿微血管血流短暂改善达 1 小时。

概括

靶向超声疗法正在开发用于预防急性冠状动脉综合征和外周血管疾病中的微血管阻塞。