Sonothrombolysis added to PCI improves recanalization rates in first time STEMI

Sonothrombolysis added to PCI improves recanalization rates and reduces infarct size in the first time STEMI, finds a new study.

PCI-added sonothrombolysis offers sustained benefit to high MI PCI compared with PCI alone for patients who have experienced a first STEMI, revealed a study published in the Journal of the American College of Cardiology.

The study outlined the advantage of sonothrombolysis in first STEMI patients. Findings of the study showed that PCI-added sonothrombolysis increases the rate of recanalization and decreases the size of the infarction, leading to continuous changes in systolic function after STEMI.

During an intravenous microbubble infusion, high mechanical index (MI) impulses from a diagnostic ultrasound transducer (DUS) may be used to attempt to restore blood flow by creating forces that dissolve thrombi termed sonothrombolysis.

Taking a cue from the prior studies which suggested that high mechanical index (MI) impulses from a diagnostic ultrasound transducer (DUS) during an intravenous microbubble infusion (Sonothrombolysis) can restore epicardial and microvascular flow in acute ST-segment elevation myocardial infarction (STEMI), the present study tested the efficacy of sonothrombolysis.

The authors prospectively randomized patients with first STEMI to either DUS-guided high MI impulses during an intravenous ultrasound agent infusion prior to, and following, emergent percutaneous coronary intervention (PCI), or to a control group that received PCI only (total number of patoents=50 in each group). A reference first STEMI group (with total number of patients=203) who arrived outside the randomization window was also analyzed. Angiographic recanalization prior to PCI, ST-segment resolution, infarct size (IS) by magnetic resonance imaging, MRI, and systolic function (LVEF) at six months were compared.

Key findings of the study

• ST-segment resolution occurred in 16 (32%) high MI PCI versus 2(4%)


• PCI only patients prior to PCI, and angiographic recanalization was 48% in high/MI PCI versus 20% in PCI only and reference groups.


• IS was reduced.


• LVEF was not different between groups before treatment, but increased immediately after PCI in the high MI/PCI group, and remained higher at six months.


• Need for an implantable defibrillator (LVEF<30%) was reduced in the high MI/PCI group.

The authors concluded that Sonothrombolysis added to Percutaneous Coronary Intervention improves recanalization rates and reduces infarct size, resulting in sustained improvements in systolic function after STEMI.