State-of-the-Art Review
Contrast Ultrasound, Sonothrombolysis and Sonoperfusion in Cardiovascular Disease: Shifting to Theragnostic Clinical Trials

https://doi.org/10.1016/j.jcmg.2021.07.028Get rights and content
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Highlights

  • Contrast ultrasound is used to delineate the endocardium and vascular endothelium, to visualize microvascular perfusion, and to enhance Doppler signals.

  • High mechanical index ultrasound pulses and contrast microbubbles are capable of reperfusion through thrombus dissolution (sonothrombolysis) and blood flow augmentation (sonoperfusion).

  • Clinical trials indicate therapeutic application of contrast ultrasound in acute myocardial infarction, stroke, and peripheral arterial disease.

  • Clinical translation depends on the outcome of ongoing trials and further improvement of ultrasound settings and microbubble properties.

Abstract

Contrast ultrasound has a variety of applications in cardiovascular medicine, both in diagnosing cardiovascular disease as well as providing prognostic information. Visualization of intravascular contrast microbubbles is based on acoustic cavitation, the characteristic oscillation that results in changes in the reflected ultrasound waves. At high power, this acoustic response generates sufficient shear that is capable of enhancing endothelium-dependent perfusion in atherothrombotic cardiovascular disease (sonoperfusion). The oscillation and collapse of microbubbles in response to ultrasound also induces microstreaming and jetting that can fragment thrombus (sonothrombolysis). Several preclinical studies have focused on identifying optimal diagnostic ultrasound settings and treatment regimens. Clinical trials have been performed in acute myocardial infarction, stroke, and peripheral arterial disease often with improved outcome. In the coming years, results of ongoing clinical trials along with innovation and improvements in sonothrombolysis and sonoperfusion will determine whether this theragnostic technique will become a valuable addition to reperfusion therapy.

Key Words

cardiovascular
contrast ultrasound
sonoperfusion
sonothrombolysis
theragnostics

Abbreviations and Acronyms

ATP
adenosine triphosphate
MB
microbubble
MI
mechanical index
NO
nitric oxide
NOS
nitric oxide synthase
PCI
percutaneous coronary intervention
PNP
peak negative pressure
rt-PA
recombinant tissue-type plasminogen activator
STEMI
ST-segment elevation myocardial infarction
TCCD
transcranial color-coded duplex
TIMI
Thrombolysis In Myocardial Infarction
t-PA
tissue plasminogen activator
UK
urokinase
US
ultrasound

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