Report from SIR: Ultrasound shows promise for treatment of thrombosis
Ultrasound may be just as safe and effective as thrombolytics or mechanical thrombectomy procedures for treating peripheral arterial occlusions, according to a study presented by German researchers at the Society of Interventional Radiology meeting in Salt Lake City last week.
Ultrasound thrombolysis uses a low-frequency, high-energy probe placed into the artery through a catheter. The probe delivers ultrasound energy to unclog the diseased vessel. The system was originally devised for long occlusive lesions that are difficult to treat using conventional angioplasty techniques.
Also known as ultrasound angioplasty, the procedure was first described in the clinical literature in the early 1990s. Although originally developed for cardiovascular use, the technique shows promise for peripheral procedures and may soon become a useful new treatment.
Using the Acolysis transcatheter ultrasound thrombolysis system alone or in combination with either thrombolytics or balloon angioplasty, investigators treated 150 patients presenting with intermittent claudication or critical limb ischemia. They found that blood flow restoration was successful in 92.9% percent of patients treated with transcatheter ultrasound therapy alone.
Recanalization was successful in 90.7% of all patients, noticeably those with femoral artery occlusions older than one year. Recanalization had a success rate of 86.2% in patients treated with Acolysis and tissue plasminogen activator (tPA), and of 90.2% in patients treated with a three-day thrombolysis therapy and Acolysis. Vessel lumen diameter increased to 3.2 mm and 4.5 mm after Acolysis and balloon angioplasty plus Acolysis, respectively.
Interventions failed in 9.3% of patients, mostly due to technical problems. No major complications were reported.
Transcatheter ultrasound is not only comparable, but in some cases superior to other mechanical declotting techniques, said lead author Dr. Gottfried Rudofsky from the University Hospital of Essen.
Researchers in California and Israel have developed similar systems for cardio and neurovascular applications. The system utilized in Rudofsky's study is currently approved for use in Europe only.
