Feasibility of Microbubble-Accelerated Low-Dose Thrombolysis of Peripheral Arterial Occlusions Using an Ultrasound Catheter

Purpose: Intra-arterial administration of microbubbles (MBs) through an ultrasound (US) catheter increases the local concentration of MBs into the thrombus and may further enhance outcomes of contrast-enhanced sonothrombolysis (CEST). The objective of this study was to evaluate the feasibility and l...

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Published in:Journal of endovascular therapy 2024-06, Vol.31 (3), p.466-473
Main Authors: Doelare, Sabrina A. N., Nederhoed, Johanna H., Evers, Josje M., Roos, Sebastiaan T., Kamp, Otto, Musters, René J. P., Wisselink, Willem, Jongkind, Vincent, Ebben, Harm P., Yeung, Kak K.
Format: Article
Language:English
Subjects:
Animals
Contrast Media - administration & dosage
Disease Models, Animal
Equipment Design
Experimental Investigations
Feasibility Studies
Fibrinolytic Agents - administration & dosage
Humans
Infusions, Intra-Arterial
Microbubbles
Peripheral Arterial Disease - diagnostic imaging
Peripheral Arterial Disease - physiopathology
Peripheral Arterial Disease - therapy
Phantoms, Imaging
Phospholipids - administration & dosage
Sulfur Hexafluoride - administration & dosage
Sus scrofa
Thrombolytic Therapy
Time Factors
Ultrasonic Therapy
Ultrasonography, Interventional
Urokinase-Type Plasminogen Activator - administration & dosage
Vascular Access Devices
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Summary:Purpose: Intra-arterial administration of microbubbles (MBs) through an ultrasound (US) catheter increases the local concentration of MBs into the thrombus and may further enhance outcomes of contrast-enhanced sonothrombolysis (CEST). The objective of this study was to evaluate the feasibility and lytic efficacy of intra-arterial infusion of MBs during US-enhanced thrombolysis in both in vitro and in vivo peripheral arterial occluded models. Materials and Methods: SonoVue and Luminity MBs were infused at a flow rate of 20 mL/h through either the drug delivery lumen of the US catheter (DDC, n=20) or through the tube lumen of the vascular phantom (systematic infusion, n=20) during thrombolysis with a low-dose urokinase (UK) protocol (50 000 IU/h) with(out) US application to assess MB survivability and size by pre-treatment and post-treatment measurements. A human thrombus was placed into a vascular phantom of the flow system to examine the lytic effects of CEST by post-treatment D-dimer concentrations measurements of 5 treatment conditions (saline, UK, UK+US, UK+US+SonoVue, and UK+US+Luminity). Thrombolytic efficacy of localized MBs and US delivery was then investigated in vivo in 5 porcine models by arterial blood flow, microcirculation, and postmortem determined thrombus weight and remaining length. Results: US exposure significantly decreased SonoVue (p=0.000) and Luminity (p=0.000) survivability by 37% and 62%, respectively. In vitro CEST treatment resulted in higher median D-dimer concentrations for the SonoVue (0.94 [0.07–7.59] mg/mL, p=0.025) and Luminity (0.83 [0.09–2.53] mg/mL, p=0.048) subgroups when compared with thrombolysis alone (0.36 [0.02–1.00] mg/mL). The lytic efficacy of CEST examined in the porcine model showed an improved median arterial blood flow of 21% (7%–79%), and a median thrombus weight and length of 1.02 (0.96–1.43) g and 2.25 (1.5–4.0) cm, respectively. One allergic reaction and 2 arrhythmias were observed due to the known allergic reaction on lipids in the porcine model. Conclusion: SonoVue and Luminity can be combined with an US catheter and could potentially accelerate thrombolytic treatment of peripheral arterial occlusions. Clinical Impact Catheter-directed thrombolysis showed to be an effective alternative to surgery for acute peripheral arterial occlusions, but this technique is still associated with several limb and life-threatening complications. The effects of thrombolysis on clot dissolution may be further enhanced by
ISSN:1526-6028
1545-1550
DOI:10.1177/15266028221126938