Key result
Adding transcutaneous ultrasound to streptokinase increases arterial patency ~10-fold versus streptokinase alone.
Why the study?
External ultrasound has a synergistic effect on thrombus disruption with thrombolytic agents in vitro, but its effect on thrombolysis in vivo was unclear.
Does transcutaneous ultrasound augment thrombolysis with streptokinase in an in vivo rabbit model of arterial thrombosis?
RCT (n=24)
randomized
Does transcutaneous ultrasound augment thrombolysis with streptokinase in an in vivo rabbit model of arterial thrombosis?
Absolute Event Rate: 59% vs 6%
p-value: p=0.0012
Transcutaneous ultrasound significantly augments the thrombolytic effect of streptokinase in vivo, suggesting a potential non-invasive adjunct to pharmacological thrombolysis.
May enhance thrombolysis when combined with streptokinase; leaves open translation to human arterial thrombosis.
BACKGROUND: External ultrasound has a synergistic effect on thrombus disruption with thrombolytic agents in vitro. We hypothesized that transcutaneous ultrasound could augment thrombolysis in vivo. METHOD AND RESULTS: Thrombus formation was induced electrically in 48 pairs of iliofemoral arteries of 24 rabbits; arterial occlusions were documented angiographically. In 17 of 24 rabbits, 25000 units/kg streptokinase was then administered intravenously. The pairs of iliofemoral arteries were randomized to receive ultrasound treatment or no ultrasound treatment. Low-frequency (26 kHz) ultrasound (continuous wave, 18 W/cm2) was applied transcutaneously over the area of occlusion. In 7 of 24 rabbits, 14 thrombotically occluded iliofemoral arteries were exposed to ultrasound alone without streptokinase. The results were evaluated through the use of angiography (TIMI grade flow) and histopathology. After 30 +/- 10 minutes of activated sonication combined with intravenous streptokinase, 10 of 17 iliofemoral arteries (59%) treated with transcutaneous ultrasound were widely patent angiographically, with TIMI grade 3 flow. Histologically, the patent arteries had only minimal focal moral thrombus. The angiographic patency rate was significantly lower in the control groups: 1 of 17 arteries (6%) treated with streptokinase alone (P = .0012) and 1 of 14 arteries (7%) treated with ultrasound alone (P = .0036). CONCLUSIONS: In vivo transcutaneous ultrasound significantly augments lysis of thrombi with streptokinase in rabbit iliofemoral arteries.
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Luo et al. (1996) conducted an RCT in Arterial thrombosis (n=24). Transcutaneous ultrasound + streptokinase vs. Streptokinase alone or ultrasound alone was evaluated on Angiographic patency (TIMI grade 3 flow) (p=0.0012). Transcutaneous ultrasound combined with intravenous streptokinase significantly increased angiographic patency of thrombosed arteries compared to streptokinase alone (59% vs 6%, P=0.0012).
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