Noninvasive treatment of deep venous thrombosis using pulsed ultrasound cavitation therapy (histotripsy) in a porcine model.
Noninvasive treatment of deep venous thrombosis using pulsed ultrasound cavitation therapy (histotripsy) in a porcine model.
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DOI：
10.1016/j.jvir.2010.10.007
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发表时间：
2011-03
影响因子：
2.9
通讯作者：
Xu, Zhen
中科院分区：
文献类型：
--
作者：
Maxwell, Adam D.;Owens, Gabe;Gurm, Hitinder S.;Ives, Kimberly;Myers, Daniel D., Jr.;Xu, Zhen
本研究评估了组织解剖学作为一种无创、图像引导的溶栓方法在猪深静脉血栓形成模型中的作用。组织解剖治疗使用短、高强度、聚焦的超声脉冲，通过实时超声成像引导的声空化对目标软组织造成机械破坏。本文是组织解剖溶栓的体内可行性研究。采用两根导管球囊闭塞并输注凝血酶的方法，在体重 30-40 kg 的幼猪股静脉中形成急性血栓。使用直径 10 厘米、1 MHz 聚焦换能器进行治疗。使用 8 MHz 超声成像仪将凝块与治疗焦点对齐。治疗包括 5 个周期脉冲，频率为 1 kHz，峰值负压在 14-19 MPa 之间。沿着血管的长轴扫描焦点，以在超声暴露期间治疗整个可见的凝块。在治疗过程中通过超声波可视化由高回声空化气泡云识别的目标区域。 12 例中有 10 例血栓破裂明显，其中 10 例血管内回声减弱，彩色多普勒测量显示，7 例静脉血流改善。血管组织学显示血管内皮剥脱，血管外膜和下面的肌肉和脂肪组织有小块出血，但从未观察到血管壁穿孔。结果表明组织解剖学有潜力发展为深静脉血栓形成的无创治疗方法。
This study evaluated histotripsy as a noninvasive, image-guided method of thrombolysis in a porcine model of deep vein thrombosis. Histotripsy therapy uses short, high-intensity, focused ultrasound pulses to cause mechanical breakdown of targeted soft tissue by acoustic cavitation, which is guided by real-time ultrasound imaging. This paper is an in-vivo feasibility study of histotripsy thrombolysis. Acute thrombi were formed in the femoral vein of juvenile pigs weighing 30–40 kg by balloon occlusion with two catheters and thrombin infusion. A 10-cm diameter 1-MHz focused transducer was used for therapy. An 8 MHz ultrasound imager was used to align the clot with the therapy focus. Therapy consisted of 5 cycle pulses delivered at a rate of 1 kHz and peak negative pressure between 14–19 MPa. The focus was scanned along the long axis of the vessel to treat the entire visible clot during ultrasound exposure. The targeted region identified by a hyperechoic cavitation bubble cloud was visualized via ultrasound during treatment. Thrombus breakdown was apparent as a decrease in echogenicity within the vessel in 10 of 12 cases, and in 7 cases, improved flow through the vein as measured by color Doppler. Vessel histology showed denudation of vascular endothelium and small pockets of hemorrhage in the vessel adventitia and underlying muscle and fatty tissue, but perforation of the vessel wall was never observed. The results indicate histotripsy has potential for development as a noninvasive treatment for deep vein thrombosis.
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