First-in-Human Experience of Targeted Coronary Sonothrombolysis: A Novel Approach for Management of Refractory Coronary Thrombus.

BACKGROUND

Intravenous sonothrombolysis is an emerging strategy for management of acute coronary syndromes. This involves intravenous administration of echocardiographic ultrasound enhancing agents with subsequent ultrasound-induced microbubble rupture using echocardiography. However, it is challenging to isolate a specific cardiac distribution. We sought to overcome this with targeted coronary sonothrombolysis.

CASE SUMMARY: In a case of acute coronary syndrome with extensive thrombus burden, targeted coronary sonothrombolysis was performed with perflutren microbubbles injected directly into the thrombus and subsequently ruptured using echocardiography, leading to significant reduction in thrombus burden and normalization of coronary flow.

DISCUSSION: Injection of perflutren microbubbles into the thrombus with subsequent opacification of only the myocardium supplied by the infarct-related artery is an effective means to deliver therapy to the appropriate location.

TAKE-HOME MESSAGE: Targeted coronary sonothrombolysis helps overcome some of the difficulties observed with sonothrombolysis and may be a novel technique for management of coronary thrombus.