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Goel L, Jiang X. Advances in Sonothrombolysis Techniques Using Piezoelectric Transducers. SENSORS 2020; 20:s20051288. [PMID: 32120902 PMCID: PMC7085655 DOI: 10.3390/s20051288] [Citation(s) in RCA: 21] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 02/21/2020] [Accepted: 02/24/2020] [Indexed: 12/11/2022]
Abstract
One of the great advancements in the applications of piezoelectric materials is the application for therapeutic medical ultrasound for sonothrombolysis. Sonothrombolysis is a promising ultrasound based technique to treat blood clots compared to conventional thrombolytic treatments or mechanical thrombectomy. Recent clinical trials using transcranial Doppler ultrasound, microbubble mediated sonothrombolysis, and catheter directed sonothrombolysis have shown promise. However, these conventional sonothrombolysis techniques still pose clinical safety limitations, preventing their application for standard of care. Recent advances in sonothrombolysis techniques including targeted and drug loaded microbubbles, phase change nanodroplets, high intensity focused ultrasound, histotripsy, and improved intravascular transducers, address some of the limitations of conventional sonothrombolysis treatments. Here, we review the strengths and limitations of these latest pre-clincial advancements for sonothrombolysis and their potential to improve clinical blood clot treatments.
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Affiliation(s)
- Leela Goel
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, USA;
- Joint Department of Biomedical Engineering, North Carolina State University and The University of North Carolina at Chapel Hill, Raleigh, NC 27695-7910, USA
| | - Xiaoning Jiang
- Department of Mechanical and Aerospace Engineering, North Carolina State University, Raleigh, NC 27695-7910, USA;
- Correspondence: ; Tel.: +1-919-515-5240
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Wang Z, Sawaguchi Y, Hirose H, Ohara K, Sakamoto S, Mitsumura H, Ogawa T, Iguchi Y, Yokoyama M. An In Vitro Assay for Sonothrombolysis Based on the Spectrophotometric Measurement of Clot Thickness. JOURNAL OF ULTRASOUND IN MEDICINE : OFFICIAL JOURNAL OF THE AMERICAN INSTITUTE OF ULTRASOUND IN MEDICINE 2017; 36:681-698. [PMID: 28150461 DOI: 10.7863/ultra.15.11018] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/10/2015] [Revised: 05/30/2016] [Indexed: 06/06/2023]
Abstract
OBJECTIVES For improved thrombolysis therapy based on ultrasound irradiation, researchers and practitioners would strongly benefit from an easy and efficient in vitro assay system of thrombolysis activity involving irradiated ultrasound. For the present study, we designed a new in vitro sonothrombolysis assay system using a sheet-type clot. METHODS We designed a cell for clot assay, and we confirmed that this clot cell did not significantly intervene in the acoustic field. Using human plasma, we made a sheet-type clot in the cell. Clot thicknesses at 100 points along 4 directions were measured photometrically at a rate of approximately 4 points/s. RESULTS The sonothrombolysis effects at 13 levels of ultrasonic intensity were obtained with only one sheet-type clot. With this method, we used a clinically oriented probe at 0.7 and 0.3 W/cm2 to confirm that sonothrombolysis took place. CONCLUSIONS We successfully established a new, easy, and efficient method for conducting in vitro sonothrombolysis assays. This method involves little intervention of either ultrasound reflection or standing waves in the clot cell. We believe that this new assay method is very useful for fundamental analyses of ultrasound's thrombolysis effects.
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Affiliation(s)
- Zuojun Wang
- Division of Medical Engineering, Research Center for Medical Sciences, the Jikei University School of Medicine, Tokyo, Japan
| | - Yoshikazu Sawaguchi
- Department of Clinical Pharmaceutics, Nihon Pharmaceutical University, Saitama, Japan
| | - Hideo Hirose
- Medical Devices Division, Kaneka Corporation, Tokyo, Japan
| | - Kazumasa Ohara
- Medical Devices Division, Kaneka Corporation, Tokyo, Japan
| | | | - Hidetaka Mitsumura
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Takeki Ogawa
- Department of Emergency Medicine, the Jikei University School of Medicine, Tokyo, Japan
| | - Yasuyuki Iguchi
- Department of Neurology, the Jikei University School of Medicine, Tokyo, Japan
| | - Masayuki Yokoyama
- Division of Medical Engineering, Research Center for Medical Sciences, the Jikei University School of Medicine, Tokyo, Japan
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Karahan O, Kutas HB, Gurbuz O, Tezcan O, Caliskan A, Yavuz C, Demirtas S, Mavitas B. Pharmacomechanical thrombolysis with a rotator thrombolysis device in iliofemoral deep venous thrombosis. Vascular 2015; 24:481-6. [PMID: 26490390 DOI: 10.1177/1708538115612637] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVE Deep venous thrombosis (DVT) is a life-threatening and morbid pathology. This study aimed to investigate the efficacy of an early thrombolysis procedure using a rotator thrombolysis device. METHODS Sixty-seven patients with acute proximal DVT were enrolled in the study. Patients' data were recorded retrospectively. Initially, an infrarenal retrievable vena cava filter was placed through the femoral vein. Then, a rotator thrombolysis device and a thrombolytic agent injection were applied to the occluded segments of the deep veins by puncturing the popliteal vein. RESULTS The identified reasons were trauma (43.3%), pregnancy (20.9%), undiagnosed (11.9%), major surgical operation (10.5%), immobilization (7.5%), and malignancy (5.9%). Immediate total recanalization was conducted in all patients, and the leg diameters returned to normal ranges in the early postoperative period. Hospital mortality or severe complications were not detected. CONCLUSION New thrombolytic devices seem to reduce in-hospital mortality risks and may potentially decrease post-thrombotic morbidity.
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Affiliation(s)
- Oguz Karahan
- Faculty of Medicine, Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey
| | - H Barıs Kutas
- Diyarbakır Training and Research Hospital, Department of Cardiovascular Surgery, Diyarbakir, Turkey
| | - Orcun Gurbuz
- Medical School of Balıkesir University, Department of Cardiovascular Surgery, Balıkesir, Turkey
| | - Orhan Tezcan
- Faculty of Medicine, Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey
| | - Ahmet Caliskan
- Faculty of Medicine, Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey
| | - Celal Yavuz
- Faculty of Medicine, Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey
| | - Sinan Demirtas
- Faculty of Medicine, Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey
| | - Binali Mavitas
- Faculty of Medicine, Department of Cardiovascular Surgery, Dicle University, Diyarbakir, Turkey
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Ultrasound-assisted thrombolysis with streptokinase improves thrombus resolution with minimal distal embolisation. J Thromb Thrombolysis 2012. [DOI: 10.1007/s11239-012-0850-3] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Removing vascular obstructions: a challenge, yet an opportunity for interventional microdevices. Biomed Microdevices 2012; 14:511-32. [PMID: 22331446 DOI: 10.1007/s10544-011-9627-2] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/28/2022]
Abstract
Cardiovascular diseases are the leading cause of death worldwide; they are mainly due to vascular obstructions which, in turn, are mainly caused by thrombi and atherosclerotic plaques. Although a variety of removal strategies has been developed for the considered obstructions, none of them is free from limitations and conclusive. The present paper analyzes the physical mechanisms underlying state-of-art removal strategies and classifies them into chemical, mechanical, laser and hybrid (namely chemo-mechanical and mechano-chemical) approaches, while also reviewing corresponding commercial/research tools/devices and procedures. Furthermore, challenges and opportunities for interventional micro/nanodevices are highlighted. In this spirit, the present review should support engineers, researchers active in the micro/nanotechnology field, as well as medical doctors in the development of innovative biomedical solutions for treating vascular obstructions. Data were collected by using the ISI Web of Knowledge portal, buyer's guides and FDA databases; devices not reported on scientific publications, as well as commercial devices no more for sale were discarded. Nearly 70% of the references were published since 2006, 55% since 2008; these percentages respectively raise to 85% and 65% as regards the section specifically reviewing state-of-art removal tools/devices and procedures.
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Meunier JM, Chang WTW, Bluett B, Wenker E, Lindsell CJ, Shaw GJ. Temperature affects thrombolytic efficacy using rt-PA and eptifibatide, an in vitro study. Ther Hypothermia Temp Manag 2012; 2:112-8. [PMID: 23667777 PMCID: PMC3621317 DOI: 10.1089/ther.2012.0007] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022] Open
Abstract
The potential for hypothermia as a neuroprotectant during stroke has led to its increase in clinical use. At the same time, combination pharmaceutical therapies for ischemic stroke using recombinant tissue plasminogen activator (rt-PA), and GP IIb-IIIa inhibitors, such as Eptifibatide (Epf ), are under study. However, there is little data on how the reactions triggered by these agents are impacted by temperature. Here, clot lysis during exposure to the combination of rt-PA and Epf is measured in an in vitro human clot model at hypothermic temperatures. The hypothesis is that lytic efficacy of rt-PA and Epf decreases with decreasing temperature. Whole blood clots from 31 volunteers were exposed to rt-PA (0.5 μg/mL) and Epf (0.63 μg/mL) in human fresh-frozen plasma (rt-PA+Epf ), rt-PA alone in plasma (rt-PA Alone), or to plasma alone (Control), at temperatures from 30°C to 37°C, for 30 minutes. Clot lysis was measured using a microscopic imaging technique; the mean fractional clot loss (FCL) at 30 minutes was used to determine lytic efficacy. Temperature had a significant impact on FCL in clots exposed to rt-PA+Epf, with the FCL being lower at 30°C to 36°C than at 37°C. The FCL remained significantly higher for rt-PA+Epf–treated clots than Controls regardless of temperature, with the exception of measurements made at 30°C when no significant differences in the FCL were observed between groups. The use of hypothermia as a neuroprotectant may negatively impact the therapeutic benefit of thrombolytic agents.
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Affiliation(s)
- Jason M. Meunier
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Wan-Tsu W. Chang
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | - Brent Bluett
- The University of Texas Southwestern at Austin, Austin, Texas
| | - Evan Wenker
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
| | | | - George J. Shaw
- Department of Emergency Medicine, University of Cincinnati, Cincinnati, Ohio
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Shaw GJ, Meunier JM, Lindsell CJ, Pancioli AM, Holland CK. Making the right choice: optimizing rt-PA and eptifibatide lysis, an in vitro study. Thromb Res 2010; 126:e305-11. [PMID: 20813398 DOI: 10.1016/j.thromres.2010.07.020] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/16/2010] [Revised: 07/19/2010] [Accepted: 07/22/2010] [Indexed: 11/17/2022]
Abstract
INTRODUCTION Recombinant tissue plasminogen activator (rt-PA) is the only FDA approved lytic therapy for acute ischemic stroke. However, there can be complications such as intra-cerebral hemorrhage. This has led to interest in adjuncts such as GP IIb-IIIa inhibitors. However, there is little data on combined therapies. Here, we measure clot lysis for rt-PA and eptifibatide in an in vitro human clot model, and determine the drug concentrations maximizing lysis. A pharmacokinetic model is used to compare drug concentrations expected in clinical trials with those used here. The hypothesis is that there is a range of rt-PA and eptifibatide concentrations that maximize in vitro clot lysis. MATERIALS AND METHODS Whole blood clots were made from blood obtained from 28 volunteers, after appropriate institutional approval. Sample clots were exposed to rt-PA and eptifibatide in human fresh-frozen plasma; rt-PA concentrations were 0, 0.5, 1, and 3.15 μg/ml, and eptifibatide concentrations were 0, 0.63, 1.05, 1.26 and 2.31 μg/ml. All exposures were for 30 minutes at 37 C. Clot width was measured using a microscopic imaging technique and mean fractional clot loss (FCL) at 30 minutes was used to determine lytic efficacy. On average, 28 clots (range: 6-148) from 6 subjects (3-24) were used in each group. RESULTS AND CONCLUSIONS FCL for control clots was 14% (95% Confidence Interval: 13-15%). FCL was 58% (55-61%) for clots exposed to both drugs at all concentrations, except those at an rt-PA concentration of 3.15 μg/ml, and eptifibatide concentrations of 1.26 μg/ml (Epf) or 2.31 μg/ml. Here, FCL was 43% (36-51) and 35% (32-38) respectively. FCL is maximized at moderate rt-PA and eptifibatide concentration; these values may approximate the average concentrations used in some rt-PA and eptifibatide treatments.
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Affiliation(s)
- George J Shaw
- Department of Emergency Medicine, University of Cincinnati, USA.
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