Declotting of embolized temporary vena cava filter by ultrasound and the Angiojet: comparative experimental in vitro studies.

RATIONALE AND OBJECTIVES: The authors perform an in vitro evaluation of the thrombolytic efficacy and the amount of "downstream" embolization induced by two new mechanical thrombectomy devices when applied to clots trapped in a temporary vena cava filter. METHODS: The first device used was a 22.5-kHz prototype intravascular ultrasound device with a flexible 0.8-mm (.032-inch) titanium 2-mm ball-tipped wire probe ensheathed in a 7-French teflon guide catheter. The device was inserted through a 10-French steering catheter. Under fluoroscopic control, ultrasound energy (26 +/- 4 watts/cm2, maximal longitudinal catheter tip amplitude 54 microm) was applied to 10 Ultravist-filled porcine thrombi (mean, 3500 mg). The second device, the Angiojet catheter, was applied to five Ultravist-filled porcine thrombi (mean, 3640 mg). The thrombi were treated while trapped in a temporary Günther vena cava filter (Cook Europe, Bjaverskov, Denmark) mounted in a vena cava flow model. The resultant "downstream" emboli were trapped in two tandem filters of decreasing pore size and weighed. RESULTS: Mean thrombus dissolution rate was 53% +/- 22% standard deviation (SD) for the ultrasound device (n = 10) and 63 % +/- 8% SD for the Angiojet (n = 5) (difference statistically significant at P = 0.03). For the ultrasound device, the mean embolic particle weight caught by the filters with mesh widths of 1 mm and 0.1 mm was 42% +/- 14% SD and 4% +/- 2% SD, respectively, of the initial thrombus weight. For the Angiojet, the respective numbers were 35% +/- 16% SD and 3% +/- 1% SD. Mean treatment time was 216 +/- 45 seconds SD for the ultrasound device and 153 +/- 21 seconds SD for the Angiojet. CONCLUSIONS: The thrombolytic efficacy of the Angiojet was significantly greater and the treatment time was significantly shorter than that of the ultrasound device. Both systems had a high embolization rate.

Thrombolysis of mural thrombus by ultrasound: an experimental in vitro study.

RATIONALE AND OBJECTIVES: The authors perform an in vitro evaluation of the thrombus fragmentation to determine the efficacy and degree of downstream clot fragment embolization that occurs during transcatheter ultrasound treatment of fibrin-rich mural thrombus in a peripheral venous flow model with variable diameter tubing. METHODS: The authors used a 22.5-kHz prototype intravascular ultrasound device with a flexible 0.8-mm (.032-inch) titanium wire probe encased in a 7-French teflon guide catheter, at the tip of which is a 2-mm ball. In 50 silicone tube segments (inner diameter 3, 5, 7, 9, and 11 mm; n = 10 each), firmly adherent mural thrombus was produced using bovine blood in a modification of the Chandler's loop technique. Ultrasound energy (30-36 watts/cm), maximal longitudinal catheter tip amplitude 70 m) was applied to the thrombus while a continuous flow of water was maintained in the closed loop system. Clot fragment emboli were trapped in "downstream" polyethylene filters. RESULTS: The mean rate of thrombus removal ranged from 99% +/- 0.3% in the 3-mm segments to 76% +/- 6% in the 11-mm segments. The average weight of the fragments that embolized "downstream" and were trapped in the filters, expressed as a percentage of the initial clot weight, was 11% in the 3-mm segment, 14% in the 5-mm segment, 30% in the 7-mm segment, 29% in the 9-mm segment, and 28% in the 11-mm segments. The majority of the embolized fragments appear to be larger than 1 mm. CONCLUSIONS: In this in vitro venous flow model a lack of catheter steerability was the major obstacle to complete thrombus fragmentation in vessel calibers larger than two times the tip diameter. The rate of embolism and the amount of remaining thrombus that could not be removed from the vessel were higher in the larger vessels.

Feasibility of recanalization of human coronary arteries using high-intensity ultrasound.

To investigate the feasibility of ultrasonic recanalization of obstructed human coronary arteries in vitro, high-intensity ultrasound was applied to 16 coronary arteries obtained at autopsy, using a prototype instrument enabling insonification through a catheter tip. It was a 119 cm long, 0.95 mm thick wire in an 8Fr catheter connected to an external ultrasonic transformer and power generator. A 5 MHz phased-array 2-dimensional echocardiography instrument was used to determine minimal luminal diameter and percent diameter narrowing before and after ultrasound application. The ultrasonic energy was delivered at 21.5 kHz and with a 52 +/- 19 micrometer average amplitude of tip displacement. The mean percent luminal diameter narrowing, flow rate and mean pressure gradient before ultrasound exposure were 74 +/- 11%, 97 +/- 61 ml/min, and 92 +/- 18 mm Hg, respectively. After recanalization, the mean percent luminal diameter narrowing decreased to 45 +/- 17% (p < 0.001), the mean flow rate increased to 84 +/- 92 ml/min (p < 0.001), and the mean pressure gradient was reduced to 45 +/- 24 mm Hg (p < 0.001). Of the debris particles, 95% had a diameter < 9 microns (range 5 to 12). Arterial perforation occurred in 5 of 16 arteries (31%) and all 5 occurred due to stiff wire manipulation and without ultrasound application. Mechanical fracture of the wire occurred in 8 cases (50%). No signs of thermal injury were found on histology. Thus, ultrasonic recanalization of human coronary arteries in vitro is feasible. It may reduce obstruction and improve blood flow. Debris sizes are sufficiently small to minimize the hazard of peripheral embolization.

Ability of high-intensity ultrasound to ablate human atherosclerotic plaques and minimize debris size.

To investigate whether high-intensity ultrasound can destroy atherosclerotic plaques while sparing the normal arterial wall, 279 normal human aortic sites and 119 fibrous and 193 calcified plaques, obtained from 24 necropsies, were insonified in a water tank, at 20 kHz and at 5 different power intensities, ranging from 68 W/cm2 (P1) to 150 W/cm2 (P5). These intensities were associated with a total excursion of the ultrasound irradiation apparatus tip from 90 to 268 microns, respectively. Time to perforate normal aortic sites and fibrous and calcified plaques was recorded at each intensity. There was no difference in perforation time between normal aortic sites and fibrous and calcified plaques when high-power levels (P2 to P5) were used. However, at the lowest power (P1), perforation time for the normal aortic wall was significantly longer than for fibrous and calcified plaques: 30 +/- 18 seconds (166 observations), 14 +/- 7 seconds (p less than 0.001) (78 observations) and 12 +/- 8 seconds (p less than 0.001) (115 observations), respectively. When perforation times for normal vessel wall versus fibrous plaque and normal vessel wall versus calcified plaque from the same necropsy specimen were compared in a pairwise manner, the results were: 29 +/- 13 vs 16 +/- 7 (p less than 0.001) (48 paired observations) and 26 +/- 9 vs 10 +/- 5 seconds (p less than 0.001) (55 paired observations), respectively. Regardless of whether paired or unpaired comparison was applied, no significant difference was found in perforation time between fibrous and calcified plaques. The debris did not differ in size as measured separately for normal sites and fibrous and calcified plaques by a computer-interfaced Channelizer and Coulter Counter system.(ABSTRACT TRUNCATED AT 250 WORDS)

Pharmacokinetics of Alcide, a germicidal compound in rat.

Alcide is a germicidal compound which is currently being used as a liquid sterilizer. This agent has the ability to kill a wide range of bacteria, viruses and fungi in vitro within 1 min. The active ingredients in this sterilizer are sodium chlorite and lactic acid. The kinetics of 36Cl-labelled liquid Alcide were studied in rats. After oral administration, the peak plasma level was obtained in 8 h. The half life for 36Cl absorption from plasma was 8.03 h, corresponding to a rate constant of 0.086 h-1, while the half life for 36Cl elimination from plasma was 48.02 h, corresponding to a rate constant of 0.014 h-1. At 144 h, radioactivity was highest in plasma followed by lung, kidney, skin, bone marrow, stomach, ovary, duodenum, ileum, spleen, fat, brain, liver and carcass. The greatest amount of activity in whole blood was present in plasma. Subcellular distribution revealed that 85% of the activity in the liver homogenate resided in the cytosol. Seventy per cent of total activity in plasma was located in the trichloroacetic acid (TCA) supernant, with 30% bound to the precipitated protein fraction. Urinary excretion accounted for most of the 36Cl eliminated. Radioactivity was excreted as chloride and chlorite in urine.